Effect of implementing clinical guidelines for treatment of symptoms in advanced cancer patients in specialist palliative care: A nationwide register-based study

Effect of implementing clinical guidelines for treatment of symptoms in advanced cancer patients in specialist palliative care: A nationwide register-based study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Effect of implementing clinical guidelines for treatment of symptoms in advanced cancer patients in specialist palliative care: A nationwide register-based study Leslye Rojas-Concha, Maiken Bang Hansen, Mathilde Adsersen, Morten Aagaard Petersen, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4595052/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 10 Dec, 2025 Read the published version in BMC Palliative Care → Version 1 posted 12 You are reading this latest preprint version Abstract Background: There is limited evidence on whether the implementation of clinical guidelines has a positive effect on the symptomatology of cancer patients in palliative care. A large national project conducted 2017-2019 aimed to improve the quality of life of cancer patients by implementing clinical guidelines for severe pain, dyspnea, constipation and depression in Danish specialist palliative care. We investigated how pain, dyspnea, constipation and depression changed from the start of palliative care to 1-4 weeks later and whether changes were associated with timing of guideline implementation and with receipt of treatment according to guidelines. Methods: A prospective, national quality improvement study. Data for the project was obtained from the Danish Palliative Care Database. We included adult patients with advanced cancer who answered the European Organisation for Research and Treatment of Cancer Quality of Life Questionnire-Core-15-Palliative Care (EORTC QLQ-C15-PAL) questionnaire at the start of specialist palliative care and 1-4 weeks later. Multiple linear regression evaluated associations between changes in symptom severity and timing of guideline implementation and receiving treatment according to guidelines. Results: Of 4,640 patients completing both EORTC QLQ-C15-PAL questionnaires, 3,879 (84%) qualified for one or more treatment guidelines. Pain, dyspnea, constipation and depression improved significantly. Timing of guideline implementation and receiving treatment according to guidelines were not associated with improvement, except for dyspnea, where small associations were observed. Conclusions: Patients reported improved pain, dyspnea, constipation and depression, but this improvement was not consistently associated with the implementation of the four guidelines in palliative care. The lack of impact may be attributed to a modest impact on clinical practice or the observational project design. Implementation Clinical Guidelines Palliative Care Pain Dyspnea Constipation Depression Quality of Life Figures Figure 1 Figure 2 Background Clinical guidelines summarize evidence-based recommendations that help physicians to make informed decisions about optimal treatment for patients. 1 Guidelines have the potential to enhance the quality of care and patient outcomes when effectively disseminated and implemented in routine care. 2, 3 The growing interest in providing better palliative care has led to the development of several international clinical guidelines to improve the quality of life of cancer patients in palliative care. 4–7 Many countries have followed these initiatives and implemented their own national palliative care guidelines, which primarily include recommendations for symptom management, patient and caregiver education, and training of clinicians. 8–13 However, successful adoption of these clinical guidelines into routine care can only be achieved when healthcare providers perceive the content of the guidelines as clear, precise and based on high levels of evidence. 14 Ideally, the effectiveness of treatments recommended in palliative care guidelines can be evaluated by measuring the change in the level of patients’ symptoms from before to after implementation of these guidelines. 15, 16 While some studies have shown that pain, fatigue, anxiety, depression and quality of life improved after clinical guidelines were implemented in palliative care, 17, 18 other studies did not find increased symptom relief when clinicians followed clinical guidelines. 19, 20 Therefore, more evidence is needed to understand whether the implementation of clinical guidelines has a positive effect on the level of symptoms experienced by patients in palliative care. A national improvement project was conducted in the 44 specialist palliative care services (palliative care teams/units and hospices) in Denmark between September 2017 and June 2019. The purpose of this project was to improve the quality of life of advanced cancer patients admitted to specialist palliative care by providing the best possible treatment according to evidence-based clinical guidelines. 21 In the project, four treatment guidelines were developed to relieve pain, dyspnea, constipation and depression. Clinicians had to implement the guidelines for patients reporting severe levels of the corresponding symptom on the European Organisation for Research and Treatment of Cancer Quality of Life Questionnire-Core-15-Palliative Care (EORTC QLQ-C15-PAL) questionnaire, i.e., patient reports of ‘quite a bit’ or ‘very much’ of the symptom. 22 The aim of this study was to investigate how the levels of pain, dyspnea, constipation, and depression changed from the start of specialist palliative care to 1–4 weeks later. Further, the study aimed to examine whether the change in the level of each symptom was associated with 1) the timing of guideline implementation (i.e., whether the patients were admitted to a palliative care service before or after the relevant guideline was implemented), and 2) whether patients received treatment according to guidelines. Methods Study design and patients This national study evaluated compliance with guideline implementation in routine palliative care, 23 by evaluating the longitudinal effect on the level of pain, dyspnea, constipation and depression in advanced cancer patients, before and after physicians adopted and implemented a treatment guideline for each of the four symptoms in the 44 specialist palliative care services in Denmark. This study included data for patients who: 1) were admitted to any of the 44 specialist palliative care services during the improvement project period i.e., between 7 September 2017 and 30 June 2019, 2) had a diagnosis of advanced cancer, 3) were at least 18 years old, 4) answered the EORTC QLQ-C15-PAL at the first day of contact with the palliative service or up to three days before, 5) reported severe levels (i.e., scoring ‘quite a bit’ or ‘very much’) of pain, dyspnea, constipation and/or depression on the EORTC QLQ-C15-PAL questionnaire at the start of palliative care, and 6) completed a second symptom assessment using the EORTC QLQ-C15-PAL at follow-up (1–4 weeks later). Data collection All data from the improvement project i.e., information on patient sociodemographic and clinical characteristics, symptom scores reported on the EORTC QLQ-C15-PAL (at the start of palliative care and follow-up), whether guidelines were followed (or not) and the type of interventions delivered to patients when physicians followed a guideline was registered in and collected from the Danish Palliative Care Database. Reporting to this database is mandatory, and it contains relevant sociodemographic and clinical data, as well as patient-reported symptoms for around 60% of patients admitted to specialist palliative care since 2010. 24 Symptom data is collected by the EORTC QLQ-C15-PAL questionnaire at the start of palliative care and at follow-up. Clinicians in each palliative service collected patient information on paper, which was later registered in a web-based system (“Clinical Measurement System”) and delivered to the Danish Palliative Care Database. 25 Setting Danish specialist palliative care is free of charge and is provided by physicians, nurses, and other professionals (e.g., psychologists) in hospital teams and hospices. 26 The majority of patients admitted to specialist palliative care have a diagnosis of advanced cancer (90%), suffer from multiple physical and psychological symptoms and their median survival from the time of referral to specialist palliative care is about 38 days. 27 In 2019, there was 44 specialist palliative care services divided into 25 palliative care teams in hospitals and 19 hospices. 27 Of the 25 palliative care teams, 5 provided inpatient and outpatient services and 20 provided only outpatient services. 27 Guideline implementation during the improvement project The national improvement project method was introduced in the Danish Healthcare System in 2015, and its first initiative was the “Learning and Quality Teams Palliative Care”, which was implemented across all specialist palliative care services between 2017 and 2019. 28 Before the project started, managers, physicians, nurses and secretaries from all palliative care services involved in the project developed technical competences through learning seminars, educational programs and national meetings. 21 During the project, physicians completed a paper survey for each patient, where they reported the symptom scores and whether they followed a treatment guideline (yes/no) when a patient qualified for it (e.g., a patient reporting severe level of dyspnea on the EORTC QLQ-C15-PAL at the start of palliative care was eligible for the dyspnea guideline), as well as what type of interventions were provided to the patient. The four treatment guidelines designed for the improvement project comprised a summary of pharmacological and non-pharmacological interventions recommended in the clinical guidelines already developed by the Danish Multidisciplinary Cancer Group for Palliative Care (DMCG-PAL). 29 These guidelines were available in each palliative care service in print and online on the DMCG-PAL website. Pharmacological interventions included, e.g., recommendations on the use of opioids for pain, 30 benzodiazepines for dyspnea, 31 and conventional laxatives to treat patients with constipation, 32 whereas non-pharmacological interventions included psychological therapy and collaborative care treatment recommended especially for patients with clinic depression. 33 In addition, all guidelines recommended ‘patient education’ on their disease and ‘caregiver training’ to relieve symptoms. 34 Further details on the type and frequency of interventions delivered during the improvement project have been reported. 35 Symptom assessment The EORTC QLQ-C15-PAL questionnaire is an abbreviated version of the EORTC Core Quality of Life Questionnaire (QLQ-C30) developed for patients in palliative care. 22 This instrument measures the level of 9 symptoms/functions (including pain, dyspnea, constipation and depression) and overall quality of life. The symptoms/functions are scored 1 (not at all), 2 (a little), 3 (quite a bit) or 4 (very much) while overall quality of life is scored from 1 (very poor) to 7 (excellent). The systematic use of this questionnaire in specialist palliative care has been a Danish national quality standard since 2010. 26 Data analyses Descriptive statistics were used to present the characteristics of patients completing the EORTC QLQ-C15-PAL at both symptom assessments during the improvement project. A patient qualified for treatment according to a guideline if reporting a severe level of a symptom on the EORTC QLQ-C15-PAL, i.e., reporting ‘quite a bit’ ( 3 ) or ‘very much’ ( 4 ) to the corresponding item for pain, dyspnea, constipation, or depression. The EORTC QLQ-C15-PAL items for the four symptoms were linearly converted into 0-100 scales, where 100 represents the worst symptom score. 36 Wilcoxon signed-rank tests were used to assess changes in the level of each symptom (mean scores) from the start of palliative care to follow-up. Multiple linear regression analyses were used to evaluate significant associations between changes in symptom severity and two independent variables: Timing of guideline implementation : This dichotomous variable was calculated by dividing patients into those who were admitted to a palliative care service before the start of the implementation of the corresponding guideline and those who were admitted afterwards. During the improvement project, each palliative care service was able to decide when to start implementing a treatment guideline i.e., when they felt that the staff was sufficiently trained and ready. We defined that a service had started the implementation of the corresponding guideline on the date the fifth patient received treatment according to the guideline. 35 Receiving treatment according to guidelines : We computed this variable by dividing patients into those who received treatment according to a guideline (i.e., when the physician reported that the corresponding guideline had been followed for a patient) and those who were reported not to receive treatment according to the guideline. These multiple linear regressions were controlled for all available patient characteristics (i.e., sex, age, having children, residence, cohabitation status, cancer diagnosis, type of palliative service and out/inpatient status). The baseline score and the interaction between timing of implementation and receiving treatment according to guidelines were added to the model for each symptom. The interactions were removed if insignificant. The significance level used was p = 0.05. Data analyses were performed using the statistical software SAS Enterprise Guide 7.1. Results Study population Figure 1 shows the inclusion of the study population. From 7 September 2017 to 30 June 2019, 11,330 advanced cancer patients answered the EORTC QLQ-C15-PAL at the start of Danish specialist palliative care and were included in the improvement project. Of these, 4,640 eligible patients also completed the EORTC QLQ-C15-PAL 1–4 weeks later, and 3,879 (84%) of these qualified for one or more treatment guidelines (i.e., reported severe levels of pain, dyspnea, constipation, or depression on the initial EORTC QLQ-C15-PAL) and thus, were included in this study. Among the 3,879 included patients, 65% qualified for treatment according to the pain guideline, 34% to the dyspnea guideline, 28% to the constipation guideline, and 23% qualified for treatment according to the depression guideline (Fig. 1). Around half of the included patients were females and a third were 70–79 years old. The majority of patients had adult children (81.1%) and lived in their private residence (96.9%) with their spouse or partner (54.4%). The most common cancer diagnoses were lung cancer (24.4%) and cancer in the digestive system (19.5%) (Table 1 ). Change in the level of symptoms and associations Figure 2 shows changes in the level of pain, dyspnea, constipation and depression from the start of palliative care to follow-up. Overall, there was significant improvement in the level of all four symptoms (p < 0.001) during the project. The changes in the mean scores differed from 20 for dyspnea to 43 for constipation. Multivariate analyses showed that the decrease in the level of symptoms was similar in the period before and after the implementation of each guideline in the 44 palliative care services, except for dyspnea, where a significantly larger decrease was observed in the period after the services had started the implementation of the dyspnea guideline (Table 2 ). We found no significant associations between the change in the level of pain, constipation and depression and whether patients received treatment according to the corresponding guideline, whereas dyspnea decreased significantly more among patients who did not receive treatment according to guidelines (Table 2 ). We also did not find significant interactions (i.e., interaction between timing of implementation and receiving treatment according to guidelines) for any of the symptoms. Table 1 Sociodemographic and clinical characteristics of the 3,879 patients included in the study. Characteristics N % Gender Male 1,883 48.5% Female 1,996 51.5% Age 18–59 720 18.6% 60–69 1,024 26.4% 70–79 1,385 35.7% 80+ 750 19.3% Having children No children 463 11.9% Children, at least one younger than 18 years 230 5.9% Children, all at least 18-years-old 3,146 81.1% Unknown 40 1.0% Residence Privat (flat, house, etc.) 3,757 96.9% Nursing home/senior residence 89 2.3% Other 22 0.6% Unknown 11 0.3% Cohabitation status Living alone 1,361 35.1% Living with spouse /partner 2,111 54.4% Living with children 81 2.1% Living with spouse /partner and children 157 4.0% Living with parents 18 0.5% Living with others 17 0.4% Unknown 134 3.5% Cancer diagnosis (ICD-10) Head and neck (C00–C14, C32) 136 3.3% Digestive system (C15-17 & C22 + 25) 801 19.5% Colorectal (C18-C20) 488 11.9% Lung (C33-34) 1,003 24.4% Breast (C50) 353 8.6% Female genital organs (C53-55 & 56, C570-C574) 247 6.0% Prostate (C61) 304 7.4% Other cancers (all other C codes) 697 16.9% Unknown primary cancer (C76-C80) 85 2.1% Type of palliative service Palliative care team 2,807 72.4% Hospice 1,072 27.6% Type of contact Outpatient 2,815 72.6% Inpatient 1,064 27.4% ICD-10: International Statistical Classification of Diseases and Related Health Problems 10th Revision Figure 2. Change in the level of pain, dyspnea, constipation, and depression from the start of palliative care to follow-up among patients completing the questionnaire at both time points. (about here) Discussion Main findings In this study, we retrospectively evaluated guideline implementation in routine palliative care by investigating how the level of pain, dyspnea, constipation, and depression changed from the start of specialist palliative care to 1–4 weeks later and whether the change in each of the four symptoms was associated with the timing of guideline implementation and receiving treatment according to clinical guidelines. We found that the levels of pain, dyspnea, constipation, and depression decreased significantly among the advanced cancer patients in specialist palliative care who qualified for the guidelines. The timing of guideline implementation and receiving treatment according to guidelines was associated with improvement of only one of the four symptoms, i.e., dyspnea, where a significantly larger improvement in dyspnea was observed after services started the implementation of the dyspnea guideline. To our surprise, dyspnea decreased more among those patients who did not receive treatment according to the corresponding guideline than among those who did. Comparison with previous literature The overall improvement in pain, dyspnea, constipation and depression observed during our project is line with a previous longitudinal study reporting that after 6 weeks of implementing the American Society of Clinical Oncology palliative care clinical guidelines in two palliative care clinics, 31 advanced cancer patients significantly improved pain, fatigue and anxiety measured by the Edmonton Symptom Assessment System (ESAS). 17 Similarly, a randomized controlled trial found that lung cancer patients assigned to the early palliative care (n = 60), i.e., where physicians and nurses had to implement and follow ambulatory clinical guidelines for symptom control during 12 weeks, had better quality of life and reduced depression than patients assigned to the standard care group (n = 40). 18 In the current study, the improvement observed in the levels of pain, constipation and depression during the project were not significantly associated with the timing of guideline implementation or receiving treatment according to guidelines. This is similar to what was reported in a randomized controlled trial, where no difference was seen after 1–4 weeks between 329 advanced cancer patients who received interventions recommended in the pain guidelines for moderate to severe pain and 359 patients who received usual care. 20 In our study, this may have happened because patients were treated equally well for pain and other symptoms regardless of whether physicians reported that they had followed the relevant guidelines for treating each symptom. Also, the clinical guidelines were known at the time and may not have revealed any new practices, so well-trained palliative care physicians' knowledge and ability to help patients would be the same before and after their implementation. The small (4.9 on a 0-100 scale) but significant improvement observed for dyspnea scores after the services started the implementation of the dyspnea guideline and among those patients who did not receive treatment according to the dyspnea guideline may be random findings, which may be related to several pragmatic reasons, for example, whether physicians had sufficient time and motivation to complete the paper survey informing whether they followed or not a relevant guideline for each patient. However, the improvement related to implementation of guidelines may also reveal that a true improvement in care took place. As we reported in our previous study, 35 qualitative data to understand the barriers (or facilitators) that clinicians may have had implementing the four guidelines and to what extent they viewed treatment according to the guidelines as different from their usual practice was not collected during the project. Strengths and limitations One of the strengths of this study is that it included a large sample of 3,879 cancer patients admitted to all specialist palliative care services in Denmark, who completed symptom assessments over time. Although we found significant improvement in the four symptoms during the project, there were some limitations that should be acknowledged. Our study did not use randomised allocation to a defined control group (receiving usual treatment) and an intervention group (receiving interventions clearly different treatment), as previous control trials did. 18–20 Instead we evaluated the impact of implementation based on the temporal pattern (before/after). Whether patients ‘received’ or ‘did not receive’ treatment according to guideline was based on registrations from physicians on each patient and this registration may to some extent be subjective, and physicians may in some cases have forgotten to register when treatment was provided according to guidelines. It should also be noted that this project only included patients reporting high levels of pain, dyspnea, constipation or depression (i.e., scores 3–4 in the EORTC QLQ-C15-PAL) at admittance to palliative care, allowing more room for improvement, since the literature has shown that patients with high initial scores tend to show greatest improvement over time. 37, 38 This is important to be aware of when interpreting the magnitude of change in scores over time for each symptom. However, this concerns all patients in the study and secured that the guidelines were studied in a relevant patient population. Future studies investigating the effect of implementing clinical guidelines for the treatment of symptoms in patients in palliative care should ideally identify patients who do or do not receive treatment according to the guidelines via random allocation to intervention group versus control group and with more detailed registration of the impact on guidelines on the specific treatments and care delivered. Additionally, implementation strategies, such as team meetings, staff training and educational programs, should be maintained throughout the implementation period to ensure that clinicians improve their adherence to clinical guidelines. 39 Conclusions In this project, patients with advanced cancer reported improved pain, dyspnea, constipation and depression. However, this symptom improvement was not associated with the implementation of the four guidelines in routine palliative care, maybe except for a small improvement in dyspnea. We cannot conclude that the implementation of the guidelines did not have a positive effect on patients’ symptoms, since the lack of impact found in this study may be attributed to a modest impact on clinical practice or the observational project design. Abbreviations DMCG-PAL: Danish Multidisciplinary Cancer Group for Palliative Care EORTC QLQ-C15-PAL: European Organisation for Research and Treatment of Cancer Quality of Life Questionnire-Core-15-Palliative Care Fig: Figure ICD-10: International Statistical Classification of Diseases and Related Health Problems 10th Revision QLQ-C30: EORTC Core Quality of Life Questionnaire Declarations Ethics approval and consent to participate : This register-based national study did not require Ethics Committee approval according to Danish law. The study was conducted following the approval from the Danish Data Protection Agency (j.nr.: 2012-58-0004/local j.nr. VD-2019-73). Consent for publication : Not applicable Availability of data and materials : The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. Competing interests: The authors declare that they have no competing interests. Funding: This study was funded by the Danish Cancer society (grant number R261-A15091). Authors' contributions: LRC and MG: Conceptualization and investigation; MBH and LRC: Methodology and formal analysis; LRC: Writing the first draft; MA, MAP, HL and MG: Writing - review and editing. All authors read and approved the final manuscript. References Field MJ and Lohr KN. Guidelines for clinical practice: from development to use. In: Committee on Clinical Practice Guidelines. Institute of Medicine, (ed.). Washington DC: National Academies Press, 1992, p. 440. Panteli D, Legido-Quigley H and Reichebner C. Clinical Practice Guidelines as a quality strategy. In: Busse R, Klazinga N, Panteli D, et al., (eds.). Improving healthcare quality in Europe: Characteristics, effectiveness and implementation of different strategies [Internet] . Copenhagen (Denmark): European Observatory on Health Systems and Policies and OECD, 2019. Van Beek K, Siouta N, Preston N, et al. To what degree is palliative care integrated in guidelines and pathways for adult cancer patients in Europe: a systematic literature review. BMC Palliat Care 2016; 15: 26. DOI: 10.1186/s12904-016-0100-0. Caraceni A, Hanks G, Kaasa S, et al. Use of opioid analgesics in the treatment of cancer pain: evidence-based recommendations from the EAPC. Lancet Oncol 2012; 13: e58-e68. DOI: 10.1016/S1470-2045(12)70040-2. Cherny N. ESMO Clinical Practice Guidelines for the management of refractory symptoms at the end of life and the use of palliative sedation. Ann Oncol 2014; 25: iii143-iii152. DOI: 10.1093/annonc/mdu238. Osman H, Shrestha S, Temin S, et al. Palliative care in the global setting: ASCO resource-stratified practice guideline. J Glob Oncol 2018: 1–24. DOI: 10.1200/jgo.18.00026. Crawford G, Dzierżanowski T, Hauser K, et al. Care of the adult cancer patient at the end of life: ESMO Clinical Practice Guidelines☆. ESMO open 2021; 6. DOI: 10.1016/j.esmoop.2021.100225. German Society for Palliative Medicine. Extended S3 Guideline Palliative Care for Patients with an Incurable Cancer [Erweiterte S3-Leitlinie Palliativmedizin für Patienten mit einer nicht heilbaren Krebserkrankung]. The AWMF (Working Group of Scientific Medical Societies) 2021, p. 1-216. Greater Manchester Medicine Management Group (GMMMG). Palliative care: Pain and symptom control guidelines for adults. 2019, p. 1-128. The Irish Health Service Executive. Management of constipation in adult patients receiving palliative care. National clinical guideline No. 10. 2015, p. 1-94. Regional Cancer Center Stockholm Gotland. National Clinical Practice Guidelines for Palliative care 2012–2014 [Nationellt Vårdprogram för Palliativ Vård 2012-2014]. Regional Cancer Center in Cooperation, Sweden, 2012, p. 60-110. The National Health Service NHS Scotland. Caring for people in the last days and hours of life - Guidance. 2014, p. 1-15. Goverment of Western Australia and Palliative Care Network. Evidence based clinical guidelines for adults in the terminal phase. Second ed. 2010, p. 1-47. Prior M, Guerin M and Grimmer-Somers K. The effectiveness of clinical guideline implementation strategies – a synthesis of systematic review findings. J Eval Clin Pract 2008; 14: 888-897. DOI: 10.1111/j.1365-2753.2008.01014.x. Ferrell BR, Twaddle ML, Melnick A, et al. National consensus project clinical practice guidelines for quality palliative care guidelines. J Palliat Med 2018; 21: 1684-1689. DOI: 10.1089/jpm.2018.0431. Lau BD, Aslakson RA, Wilson RF, et al. Methods for improving the quality of palliative care delivery: a systematic review. Am J Hosp Palliat Care 2014; 31: 202-210. 20130326. DOI: 10.1177/1049909113482039. Koesel N, Tocchi C, Burke L, et al. Symptom distress: Implementation of Palliative Care Guidelines to Improve Pain, Fatigue, and Anxiety in Patients With Advanced Cancer. Clin J Oncol Nurs 2019; 23: 149-155. DOI: 10.1188/19.CJON.149-155. Temel JS, Greer JA, Muzikansky A, et al. Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med 2010; 363: 733-742. DOI: 10.1056/NEJMoa1000678. Bakitas M, Lyons KD, Hegel MT, et al. Effects of a Palliative Care Intervention on Clinical Outcomes in Patients With Advanced Cancer: The Project ENABLE II Randomized Controlled Trial. JAMA 2009; 302: 741-749. DOI: 10.1001/jama.2009.1198. Lovell MR, Phillips JL, Luckett T, et al. Effect of Cancer Pain Guideline Implementation on Pain Outcomes Among Adult Outpatients With Cancer-Related Pain: A Stepped Wedge Cluster Randomized Trial. JAMA Netw Open 2022; 5: e220060. 20220201. DOI: 10.1001/jamanetworkopen.2022.0060. Danish Regions. Learning and quality teams-LKT in specialized palliative care: project description [Lærings og kvalitetsteam på det specialiserede palliative område: projekt beskrivelse]. 2016, p. 1-27. Groenvold M, Petersen MA, Aaronson NK, et al. The development of the EORTC QLQ-C15-PAL: a shortened questionnaire for cancer patients in palliative care. Eur J Cancer 2006; 42: 55-64. DOI: 10.1093/jnci/85.5.36510.1016/j.ejca.2005.06.022. Proctor E, Silmere H, Raghavan R, et al. Outcomes for implementation research: conceptual distinctions, measurement challenges, and research agenda. Adm Policy Ment Health 2011; 38: 65-76. DOI: 10.1007/s10488-010-0319-7. Hansen MB, Adsersen M and Groenvold M. Report from the Danish Palliative Database 2021 [Årsrapport for Dansk Palliativ Database 2021]. 2022, p. 1-103. Groenvold M, Adsersen M and Hansen MB. Danish palliative care database. Clin Epidemiol 2016; 8: 637-643. DOI: 10.2147/clep.s99468. Danish Health Authority. Recommendations for Palliative Care [Anbefalinger For Den Palliativ Indsats] 2017, p. 1-54. Hansen MB, Adsersen M and Groenvold M. Report from the Danish Palliative Database 2019 [Årsrapport for Dansk Palliativ Database 2019]. 2020, p. 1-71. Danish Health Authority. Danish Regions: The national quality program [Danske Regioner: Det nationale kvalitetsprogram], https://www.regioner.dk/sundhed/kvalitet-og-styring/det-nationale-kvalitetsprogram (2016, accessed 15 Jan 2023). Danish Multidisciplinary Cancer Group for Palliative Care (DMCG-PAL). Approved clinical guidelines [Godkendte retningslinjer], http://www.dmcgpal.dk/661/godkendteretningslinjer (2013, accessed 12 May 2023). Danish Multidisciplinary Cancer Group for Palliative Care (DMCG-PAL). Clinical guideline for pain treatment with strong opioids [Klinisk retningslinje for smertebehandling med stærke opioider], http://www.dmcgpal.dk/files/opioider_221020.pdf (2015, accessed 30 July 2023). Danish Multidisciplinary Cancer Group for Palliative Care (DMCG-PAL). Pharmacological interventions to relieve refractory dyspnea in adult cancer patients in terminal palliative phase [Farmakologiske interventioner til lindring af refraktær dyspnø hos voksne kræftpatienter i sen eller terminal palliativ fase], http://www.dmcgpal.dk/files/kliniske-retningslinjer/dyspnoe/farma_dyspn__til_publikation-1.pdf (2019, accessed 18 July 2023). Danish Multidisciplinary Cancer Group for Palliative Care (DMCG-PAL). Clinical guideline for the pharmacological treatment of constipation [Klinisk retningslinje om farmakologisk behandling af obstipation] http://www.dmcgpal.dk/files/obstipation_farma_221020.pdf (2017, accessed 20 July 2023). Danish Multidisciplinary Cancer Group for Palliative Care (DMCG-PAL). Clinical guideline for the treatment of clinical depression in cancer patients ≥18 years [Klinisk retningslinje for behandling af klinisk depression hos kræftpatienter ≥18 år], http://www.dmcgpal.dk/files/depression_voksne_221020.pdf (2017, accessed 21 July 2023). Danish Multidisciplinary Cancer Group for Palliative Care (DMCG-PAL). Clinical guideline for interventions that support adult relatives of cancer patients in palliative care [Klinisk retningslinje om interventioner, der støtter voksne pårørende til kræftpatienter i palliativt forløb], http://www.dmcgpal.dk/files/kliniske-retningslinjer/paaroeende/dmcgpal_voksne-parorende_adm_godk_260819.pdf (2013, accessed 31 July 2023). Rojas-Concha L, Hansen MB, Adsersen M, et al. Implementation of clinical guidelines in specialized palliative care—results from a national improvement project: A national register-based study. Palliat Med 2023; 37: 749-759. DOI: 10.1177/02692163231155977. Groenvold M and Petersen MA. Addendum to the EORTC QLQ-C30 scoring manual: scoring of the EORTC QLQ-C15-PAL. EORTC Quality of Life Group, Brussels 2006: 1-10. Rasmussen CL, Johnsen AT, Petersen MA, et al. Change in health-related quality of life over 1 month in cancer patients with high initial levels of symptoms and problems. Qual Life Res 2016; 25: 2669–2674. DOI: 10.1007/s11136-016-1287-5. Modonesi C, Scarpi E, Maltoni M, et al. Impact of Palliative Care Unit Admission on Symptom Control Evaluated by the Edmonton Symptom Assessment System. J Pain Symptom Manage 2005; 30: 367-373. DOI: 10.1016/j.jpainsymman.2005.04.007. Butow P, Faris MM, Shaw J, et al. Effect of core versus enhanced implementation strategies on adherence to a clinical pathway for managing anxiety and depression in cancer patients in routine care: a cluster randomised controlled trial. Implement Sci 2023; 18: 18. DOI: 10.1186/s13012-023-01269-0. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 10 Dec, 2025 Read the published version in BMC Palliative Care → Version 1 posted Editorial decision: Revision requested 08 Apr, 2025 Reviews received at journal 06 Sep, 2024 Reviews received at journal 03 Sep, 2024 Reviews received at journal 30 Aug, 2024 Reviewers agreed at journal 27 Aug, 2024 Reviewers agreed at journal 25 Aug, 2024 Reviewers agreed at journal 14 Aug, 2024 Reviewers invited by journal 08 Aug, 2024 Editor invited by journal 18 Jun, 2024 Editor assigned by journal 18 Jun, 2024 Submission checks completed at journal 18 Jun, 2024 First submitted to journal 17 Jun, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4595052","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":316905736,"identity":"5694d4eb-6bf2-4785-9c5a-5f1350c0919c","order_by":0,"name":"Leslye Rojas-Concha","email":"data:image/png;base64,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","orcid":"","institution":"Palliative Care Research Unit, Department of Geriatrics and Palliative Medicine GP, Bispebjerg and Frederiksberg Hospital, University of Copenhagen","correspondingAuthor":true,"prefix":"","firstName":"Leslye","middleName":"","lastName":"Rojas-Concha","suffix":""},{"id":316905737,"identity":"499ec581-73cf-4808-8c7b-0d614b99402c","order_by":1,"name":"Maiken Bang Hansen","email":"","orcid":"","institution":"Department of Cancer and Cancer Screening, The Danish Clinical Quality Program – National Clinical Registries (RKKP)","correspondingAuthor":false,"prefix":"","firstName":"Maiken","middleName":"Bang","lastName":"Hansen","suffix":""},{"id":316905738,"identity":"7c529cf3-617a-4c8d-891b-1794b1f9fc91","order_by":2,"name":"Mathilde Adsersen","email":"","orcid":"","institution":"Palliative Care Research Unit, Department of Geriatrics and Palliative Medicine GP, Bispebjerg and Frederiksberg Hospital, University of Copenhagen","correspondingAuthor":false,"prefix":"","firstName":"Mathilde","middleName":"","lastName":"Adsersen","suffix":""},{"id":316905739,"identity":"a5ec6fbf-4096-4b50-8e32-c5d104938312","order_by":3,"name":"Morten Aagaard Petersen","email":"","orcid":"","institution":"Palliative Care Research Unit, Department of Geriatrics and Palliative Medicine GP, Bispebjerg and Frederiksberg Hospital, University of Copenhagen","correspondingAuthor":false,"prefix":"","firstName":"Morten","middleName":"Aagaard","lastName":"Petersen","suffix":""},{"id":316905740,"identity":"9b48a8b3-e97e-4417-9265-c10a7804fd9c","order_by":4,"name":"Henrik Larsen","email":"","orcid":"","institution":"Department of Oncology, Section of Palliative Medicine, Rigshospitalet","correspondingAuthor":false,"prefix":"","firstName":"Henrik","middleName":"","lastName":"Larsen","suffix":""},{"id":316905741,"identity":"d3d7eae8-6353-4aca-a58e-9effb368b1fa","order_by":5,"name":"Mogens Groenvold","email":"","orcid":"","institution":"Palliative Care Research Unit, Department of Geriatrics and Palliative Medicine GP, Bispebjerg and Frederiksberg Hospital, University of Copenhagen","correspondingAuthor":false,"prefix":"","firstName":"Mogens","middleName":"","lastName":"Groenvold","suffix":""}],"badges":[],"createdAt":"2024-06-17 15:19:54","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4595052/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4595052/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12904-025-01969-y","type":"published","date":"2025-12-10T15:59:09+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":60426898,"identity":"48d9d023-fce9-4d1d-89d5-5d76f55b7d40","added_by":"auto","created_at":"2024-07-16 15:48:28","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":996846,"visible":true,"origin":"","legend":"\u003cp\u003eInclusion of patients.\u003cem\u003e (about here)\u003c/em\u003e\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4595052/v1/b0bfe9611fea21e2f0b945e3.jpg"},{"id":60426899,"identity":"83360a57-2add-40d0-99e2-15603033f657","added_by":"auto","created_at":"2024-07-16 15:48:28","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":905654,"visible":true,"origin":"","legend":"\u003cp\u003eChange in the level of pain, dyspnea, constipation, and depression from the start of palliative care to follow-up among patients completing the questionnaire at both time points. \u003cem\u003e(about here)\u003c/em\u003e\u003c/p\u003e","description":"","filename":"2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4595052/v1/dd8eb69eb498d384f869e681.jpg"},{"id":98244658,"identity":"32a57657-0413-446f-9a5c-b8f390e3cdec","added_by":"auto","created_at":"2025-12-15 16:14:36","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2775358,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4595052/v1/5de7a3fb-1dde-47a4-b461-1c954a2ff174.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Effect of implementing clinical guidelines for treatment of symptoms in advanced cancer patients in specialist palliative care: A nationwide register-based study","fulltext":[{"header":"Background","content":"\u003cp\u003eClinical guidelines summarize evidence-based recommendations that help physicians to make informed decisions about optimal treatment for patients.\u003csup\u003e1\u003c/sup\u003e Guidelines have the potential to enhance the quality of care and patient outcomes when effectively disseminated and implemented in routine care.\u003csup\u003e2, 3\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThe growing interest in providing better palliative care has led to the development of several international clinical guidelines to improve the quality of life of cancer patients in palliative care.\u003csup\u003e4\u0026ndash;7\u003c/sup\u003e Many countries have followed these initiatives and implemented their own national palliative care guidelines, which primarily include recommendations for symptom management, patient and caregiver education, and training of clinicians.\u003csup\u003e8\u0026ndash;13\u003c/sup\u003e However, successful adoption of these clinical guidelines into routine care can only be achieved when healthcare providers perceive the content of the guidelines as clear, precise and based on high levels of evidence.\u003csup\u003e14\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eIdeally, the effectiveness of treatments recommended in palliative care guidelines can be evaluated by measuring the change in the level of patients\u0026rsquo; symptoms from before to after implementation of these guidelines.\u003csup\u003e15, 16\u003c/sup\u003e While some studies have shown that pain, fatigue, anxiety, depression and quality of life improved after clinical guidelines were implemented in palliative care,\u003csup\u003e17, 18\u003c/sup\u003e other studies did not find increased symptom relief when clinicians followed clinical guidelines.\u003csup\u003e19, 20\u003c/sup\u003e Therefore, more evidence is needed to understand whether the implementation of clinical guidelines has a positive effect on the level of symptoms experienced by patients in palliative care.\u003c/p\u003e \u003cp\u003eA national improvement project was conducted in the 44 specialist palliative care services (palliative care teams/units and hospices) in Denmark between September 2017 and June 2019. The purpose of this project was to improve the quality of life of advanced cancer patients admitted to specialist palliative care by providing the best possible treatment according to evidence-based clinical guidelines.\u003csup\u003e21\u003c/sup\u003e In the project, four treatment guidelines were developed to relieve pain, dyspnea, constipation and depression. Clinicians had to implement the guidelines for patients reporting severe levels of the corresponding symptom on the European Organisation for Research and Treatment of Cancer Quality of Life Questionnire-Core-15-Palliative Care (EORTC QLQ-C15-PAL) questionnaire, i.e., patient reports of \u0026lsquo;quite a bit\u0026rsquo; or \u0026lsquo;very much\u0026rsquo; of the symptom.\u003csup\u003e22\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThe aim of this study was to investigate how the levels of pain, dyspnea, constipation, and depression changed from the start of specialist palliative care to 1\u0026ndash;4 weeks later. Further, the study aimed to examine whether the change in the level of each symptom was associated with 1) the timing of guideline implementation (i.e., whether the patients were admitted to a palliative care service before or after the relevant guideline was implemented), and 2) whether patients received treatment according to guidelines.\u003c/p\u003e "},{"header":"Methods","content":"\n\u003ch3\u003eStudy design and patients\u003c/h3\u003e\n\u003cp\u003eThis national study evaluated compliance with guideline implementation in routine palliative care,\u003csup\u003e23\u003c/sup\u003e by evaluating the longitudinal effect on the level of pain, dyspnea, constipation and depression in advanced cancer patients, before and after physicians adopted and implemented a treatment guideline for each of the four symptoms in the 44 specialist palliative care services in Denmark.\u003c/p\u003e \u003cp\u003eThis study included data for patients who: 1) were admitted to any of the 44 specialist palliative care services during the improvement project period i.e., between 7 September 2017 and 30 June 2019, 2) had a diagnosis of advanced cancer, 3) were at least 18 years old, 4) answered the EORTC QLQ-C15-PAL at the first day of contact with the palliative service or up to three days before, 5) reported severe levels (i.e., scoring \u0026lsquo;quite a bit\u0026rsquo; or \u0026lsquo;very much\u0026rsquo;) of pain, dyspnea, constipation and/or depression on the EORTC QLQ-C15-PAL questionnaire at the start of palliative care, and 6) completed a second symptom assessment using the EORTC QLQ-C15-PAL at follow-up (1\u0026ndash;4 weeks later).\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eData collection\u003c/h2\u003e \u003cp\u003e All data from the improvement project i.e., information on patient sociodemographic and clinical characteristics, symptom scores reported on the EORTC QLQ-C15-PAL (at the start of palliative care and follow-up), whether guidelines were followed (or not) and the type of interventions delivered to patients when physicians followed a guideline was registered in and collected from the Danish Palliative Care Database.\u003c/p\u003e \u003cp\u003eReporting to this database is mandatory, and it contains relevant sociodemographic and clinical data, as well as patient-reported symptoms for around 60% of patients admitted to specialist palliative care since 2010.\u003csup\u003e24\u003c/sup\u003e Symptom data is collected by the EORTC QLQ-C15-PAL questionnaire at the start of palliative care and at follow-up. Clinicians in each palliative service collected patient information on paper, which was later registered in a web-based system (\u0026ldquo;Clinical Measurement System\u0026rdquo;) and delivered to the Danish Palliative Care Database.\u003csup\u003e25\u003c/sup\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eSetting\u003c/h2\u003e \u003cp\u003eDanish specialist palliative care is free of charge and is provided by physicians, nurses, and other professionals (e.g., psychologists) in hospital teams and hospices.\u003csup\u003e26\u003c/sup\u003e The majority of patients admitted to specialist palliative care have a diagnosis of advanced cancer (90%), suffer from multiple physical and psychological symptoms and their median survival from the time of referral to specialist palliative care is about 38 days.\u003csup\u003e27\u003c/sup\u003e In 2019, there was 44 specialist palliative care services divided into 25 palliative care teams in hospitals and 19 hospices.\u003csup\u003e27\u003c/sup\u003e Of the 25 palliative care teams, 5 provided inpatient and outpatient services and 20 provided only outpatient services.\u003csup\u003e27\u003c/sup\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eGuideline implementation during the improvement project\u003c/h2\u003e \u003cp\u003eThe national improvement project method was introduced in the Danish Healthcare System in 2015, and its first initiative was the \u0026ldquo;Learning and Quality Teams Palliative Care\u0026rdquo;, which was implemented across all specialist palliative care services between 2017 and 2019.\u003csup\u003e28\u003c/sup\u003e Before the project started, managers, physicians, nurses and secretaries from all palliative care services involved in the project developed technical competences through learning seminars, educational programs and national meetings.\u003csup\u003e21\u003c/sup\u003e\u003c/p\u003e \u003cp\u003e During the project, physicians completed a paper survey for each patient, where they reported the symptom scores and whether they followed a treatment guideline (yes/no) when a patient qualified for it (e.g., a patient reporting severe level of dyspnea on the EORTC QLQ-C15-PAL at the start of palliative care was eligible for the dyspnea guideline), as well as what type of interventions were provided to the patient.\u003c/p\u003e \u003cp\u003eThe four treatment guidelines designed for the improvement project comprised a summary of pharmacological and non-pharmacological interventions recommended in the clinical guidelines already developed by the Danish Multidisciplinary Cancer Group for Palliative Care (DMCG-PAL).\u003csup\u003e29\u003c/sup\u003e These guidelines were available in each palliative care service in print and online on the DMCG-PAL website.\u003c/p\u003e \u003cp\u003ePharmacological interventions included, e.g., recommendations on the use of opioids for pain,\u003csup\u003e30\u003c/sup\u003e benzodiazepines for dyspnea,\u003csup\u003e31\u003c/sup\u003e and conventional laxatives to treat patients with constipation,\u003csup\u003e32\u003c/sup\u003e whereas non-pharmacological interventions included psychological therapy and collaborative care treatment recommended especially for patients with clinic depression.\u003csup\u003e33\u003c/sup\u003e In addition, all guidelines recommended \u0026lsquo;patient education\u0026rsquo; on their disease and \u0026lsquo;caregiver training\u0026rsquo; to relieve symptoms.\u003csup\u003e34\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eFurther details on the type and frequency of interventions delivered during the improvement project have been reported.\u003csup\u003e35\u003c/sup\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eSymptom assessment\u003c/h2\u003e \u003cp\u003eThe EORTC QLQ-C15-PAL questionnaire is an abbreviated version of the EORTC Core Quality of Life Questionnaire (QLQ-C30) developed for patients in palliative care.\u003csup\u003e22\u003c/sup\u003e This instrument measures the level of 9 symptoms/functions (including pain, dyspnea, constipation and depression) and overall quality of life. The symptoms/functions are scored 1 (not at all), 2 (a little), 3 (quite a bit) or 4 (very much) while overall quality of life is scored from 1 (very poor) to 7 (excellent). The systematic use of this questionnaire in specialist palliative care has been a Danish national quality standard since 2010.\u003csup\u003e26\u003c/sup\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eData analyses\u003c/h2\u003e \u003cp\u003eDescriptive statistics were used to present the characteristics of patients completing the EORTC QLQ-C15-PAL at both symptom assessments during the improvement project.\u003c/p\u003e \u003cp\u003eA patient qualified for treatment according to a guideline if reporting a severe level of a symptom on the EORTC QLQ-C15-PAL, i.e., reporting \u0026lsquo;quite a bit\u0026rsquo; (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) or \u0026lsquo;very much\u0026rsquo; (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e) to the corresponding item for pain, dyspnea, constipation, or depression. The EORTC QLQ-C15-PAL items for the four symptoms were linearly converted into 0-100 scales, where 100 represents the worst symptom score.\u003csup\u003e36\u003c/sup\u003e Wilcoxon signed-rank tests were used to assess changes in the level of each symptom (mean scores) from the start of palliative care to follow-up.\u003c/p\u003e \u003cp\u003eMultiple linear regression analyses were used to evaluate significant associations between changes in symptom severity and two independent variables:\u003c/p\u003e \u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eTiming of guideline implementation\u003c/span\u003e: This dichotomous variable was calculated by dividing patients into those who were admitted to a palliative care service before the start of the implementation of the corresponding guideline and those who were admitted afterwards. During the improvement project, each palliative care service was able to decide when to start implementing a treatment guideline i.e., when they felt that the staff was sufficiently trained and ready. We defined that a service had started the implementation of the corresponding guideline on the date the fifth patient received treatment according to the guideline.\u003csup\u003e35\u003c/sup\u003e\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eReceiving treatment according to guidelines\u003c/span\u003e: We computed this variable by dividing patients into those who received treatment according to a guideline (i.e., when the physician reported that the corresponding guideline had been followed for a patient) and those who were reported not to receive treatment according to the guideline.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e \u003cp\u003eThese multiple linear regressions were controlled for all available patient characteristics (i.e., sex, age, having children, residence, cohabitation status, cancer diagnosis, type of palliative service and out/inpatient status). The baseline score and the interaction between timing of implementation and receiving treatment according to guidelines were added to the model for each symptom. The interactions were removed if insignificant. The significance level used was p\u0026thinsp;=\u0026thinsp;0.05.\u003c/p\u003e \u003cp\u003eData analyses were performed using the statistical software SAS Enterprise Guide 7.1.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\n \u003ch2\u003eStudy population\u003c/h2\u003e\n \u003cp\u003eFigure 1 shows the inclusion of the study population. From 7 September 2017 to 30 June 2019, 11,330 advanced cancer patients answered the EORTC QLQ-C15-PAL at the start of Danish specialist palliative care and were included in the improvement project. Of these, 4,640 eligible patients also completed the EORTC QLQ-C15-PAL 1\u0026ndash;4 weeks later, and 3,879 (84%) of these qualified for one or more treatment guidelines (i.e., reported severe levels of pain, dyspnea, constipation, or depression on the initial EORTC QLQ-C15-PAL) and thus, were included in this study.\u003c/p\u003e\n \u003cp\u003eAmong the 3,879 included patients, 65% qualified for treatment according to the pain guideline, 34% to the dyspnea guideline, 28% to the constipation guideline, and 23% qualified for treatment according to the depression guideline (Fig.\u0026nbsp;1).\u003c/p\u003e\n \u003cp\u003eAround half of the included patients were females and a third were 70\u0026ndash;79 years old. The majority of patients had adult children (81.1%) and lived in their private residence (96.9%) with their spouse or partner (54.4%). The most common cancer diagnoses were lung cancer (24.4%) and cancer in the digestive system (19.5%) (Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\n \u003ch2\u003eChange in the level of symptoms and associations\u003c/h2\u003e\n \u003cp\u003eFigure 2 shows changes in the level of pain, dyspnea, constipation and depression from the start of palliative care to follow-up. Overall, there was significant improvement in the level of all four symptoms (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) during the project. The changes in the mean scores differed from 20 for dyspnea to 43 for constipation.\u003c/p\u003e\n \u003cp\u003eMultivariate analyses showed that the decrease in the level of symptoms was similar in the period before and after the implementation of each guideline in the 44 palliative care services, except for dyspnea, where a significantly larger decrease was observed in the period after the services had started the implementation of the dyspnea guideline (Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\n \u003cp\u003eWe found no significant associations between the change in the level of pain, constipation and depression and whether patients received treatment according to the corresponding guideline, whereas dyspnea decreased significantly more among patients who did \u003cem\u003enot\u003c/em\u003e receive treatment according to guidelines (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e). We also did not find significant interactions (i.e., interaction between timing of implementation and receiving treatment according to guidelines) for any of the symptoms.\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eSociodemographic and clinical characteristics of the 3,879 patients included in the study.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"3\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCharacteristics\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1,883\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e48.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1,996\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e51.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18\u0026ndash;59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e720\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e18.6%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e60\u0026ndash;69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1,024\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e26.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e70\u0026ndash;79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1,385\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e35.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e80+\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e750\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e19.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eHaving children\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo children\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e463\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e11.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eChildren, at least one younger than 18 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e230\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eChildren, all at least 18-years-old\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3,146\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e81.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUnknown\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eResidence\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePrivat (flat, house, etc.)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3,757\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e96.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNursing home/senior residence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.6%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUnknown\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eCohabitation status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLiving alone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1,361\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e35.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLiving with spouse /partner\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2,111\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e54.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLiving with children\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLiving with spouse /partner and children\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e157\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLiving with parents\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLiving with others\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUnknown\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e134\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eCancer diagnosis (ICD-10)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHead and neck (C00\u0026ndash;C14, C32)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e136\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDigestive system (C15-17 \u0026amp; C22\u0026thinsp;+\u0026thinsp;25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e801\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e19.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eColorectal (C18-C20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e488\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e11.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLung (C33-34)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1,003\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e24.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBreast (C50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e353\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e8.6%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemale genital organs (C53-55 \u0026amp; 56, C570-C574)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e247\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eProstate (C61)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e304\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e7.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOther cancers (all other C codes)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e697\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e16.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUnknown primary cancer (C76-C80)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eType of palliative service\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePalliative care team\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2,807\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e72.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHospice\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1,072\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e27.6%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eType of contact\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOutpatient\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2,815\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e72.6%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eInpatient\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1,064\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e27.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003eICD-10: International Statistical Classification of Diseases and Related Health Problems 10th Revision\u003c/p\u003e\n \u003cp\u003eFigure 2. Change in the level of pain, dyspnea, constipation, and depression from the start of palliative care to follow-up among patients completing the questionnaire at both time points. \u003cem\u003e(about here)\u003c/em\u003e\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\n \u003cdiv align=\"left\" class=\"colspec\"\u003e\u003cimg 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q4GPKUs7buQ9lrdcOlQ/sV1RneOeymuKwkzTyjHuufIoc8+huo7lRHGmnfWyslA5x+TKAggzTRtlgN84DK5vInOQix+q0sW5OhnFT5r+Nu2E4olR/MhgHL/kJHVXPcfpkG6zj8m1gbl6IHzKMM4rpDYHOMZv7BbXQ+yueozzTLxpGSivcecTf7jV2WTIueXymWtXALc0TaA0xOWicJvon/ziVidbo4J447ipL9LGcRP9Iu2pP66lraejDJzDT5q/nDyVlYX6OHE8QB2m9VdV/03KflCbDIorBfc4PpV30zLK5U1+YnL+QPlNbYPsVuouW6J0NU0n5zluUt7ym9Zjjtz1Snvshr+mcpnGy83kksl+WJqXNjoex610yf6l8eXCgbI6VPixHCreOOxhyXGb8igDeSEdMarbVAar0pCWpcJQmUObcsdPGleuPSqLH9IwQemqa79UP3H6IdUv/FTd0/VDruzKdKtJXqBpf64Mrs2VZXovqbhTmcQtvr5pHvmva2MbUnW96gZ0fdxHblq3yFlathyn1+VQOcS0yUsO1Rdpj/MovcBd4TYtX8AtrhvQ9Wn+c/layDRao60f9thjj7Am2W677RaOJ+Pq7bTTTuF/Dt5Lj/mHf/iHsH/00UfDvgw+g8xnm4877rgQh7bvfOc74fzjjz8e9m249dZbe5OCU/sBiCawFhuLmZ9++umFS6937bXXhv1tt90W9iksfP73f//3Ye0Oce655xb/eqEcWcdl0kiFvMKJJ544o3z58MKkQdjuXf9LL7007G8qFt5V+Z199tnhWFx22WW9f/7nf56R7hw77LBDqOf999+/cJlyG5Sm6Y9hnZMcrMUHShcfwFC5UdY//OEPw/8mxGsQkrYbbrgh/OdDGsCnq4G1emJ5nDTgwb3u8+TU46Qh3G59wKOOOirs77nnnrCHzz77rPfGG29My2lTXbjzzjuDH+pNfvhPvKwTo/ISxxxzTHYxfj77PRukMqm0pe6TN3vFv2awFmVubYx4ceF333037GN7Rfxax/LTTz8N+zIeKj6Ecuyxx4a9IO3ICPU3yKfdWRMPYjmVfEw2wGHfFXw2nzBT20EZSt5FW5lrS52MDqOdiPnRj340I/4dd9wx7FP33Xffvfj3LXvuuWfYn3nmmWEvaAOgrg1sa3OQ1Vg+lL7UPacL2N2TTz55Rjxq43NrmtbZ5DKG1a70o3/jZv8mO7HTOk19kbam+kX9kdc4P4RFW8/HrGDQNgzUx7n//vvDXjz44IO9U089tTiqp0nZD2qT68iVd9My4nj58uXhP+Anl586Utugvl7qLlsi2tZl17Le9D6gqVwiy6n80PeiLyTb1Y+Os+ac4lZdS3bT+CRXbeCaYfctyuiiz8H9Rprvww8/POzr1ptuS5tyb9setaWu/WqqX9Rj1T1dP7S9x67LS5v+XA71sdrcS+bc+DChaJvHJvaraR+5ad2SvnXr1oU1EjkPp512WtgPQr+2WHYGfYnzyL0l99TY0Ndeey24tS3fMvrt5y0UhjbQhgLR+P2rf/WvgvBeeOGF2cGRMiQgGPgq3n///bA/6KCDen/+538+vV1wwQW9RYsWtb65RFmIky9/dQGDdpdffvkMRV25cmXoABNPThDppGIM/vIv/7K3du3aYJzPP//84uxUg0nnjU4WAr5p06YQrvxg8Mh3TklRwrjzLWORuwFsAvVEPZMO0nnzzTf3/uN//I/F2f5ok/42cC1ysX79+t4+++wzPVAZl21b1CmS8SbtpC2WRbbf/OY3QR7/3//7f8FfFatWrQr5p+ETL730UjCS+lAHPP/88zMa66a6gNzRCYn9sPGlI/x98sknwZ8pp6yM6gYDVH852aZ+QTo5CLnOL3rTJU8++WTY52xHOsg52zLXdTsxCugYQV0b2IXNaQIyRTyUWRwPZUo8bF3ddA2jXYFR6d+oaaJftJfUXzoYk9KFPNFHwd7oS+sg2dCNQNf0a5P7oWkZMUjEjSP9DMr/jDPOGKl8jco2lNHkPqCpXOphSJ38dKXjGqhJ4xuW/Iqu5bir8tiyZUvxbyY777xz8a8bmpb7KNujMprqV909XT8Meo+d0qY/l0My1O+9pKA8Rdd5jMnJRtxHblq31CPHf/3Xfx3SRzrpv2jwbpzgwS9oUH+Y5Wu+ZWgDbUDF0VE+/vjjw4wcBhC6hi8awp/+9Kcwap5uH3zwQTjfBATuyiuvDLPpco1SWwiPRo4wU2XV55t5Ep2C8DOwQhq4FuO8MfpqI+48xVuzZk2YLUfZ0oHT05Jvvvkm7MvIPRkaBOK96qqrev/6X//rcKyn2f0yzPTT8eXpAwb0rLPOCmExuNoVGG86LzlZZNPT2Sr0NEQNH2HSAFxyySUh3eo4PfDAAzOeUjbVBfSSGZs5P2zIn8nD7AZAP2PQdToj8ROkHHEnIoUO4qBodqaeWIHsQtf12qYTO9sy12U7MW50YXOaoBkV2KVcPGxd3oR23a7AsPVvtuhSv7qQJ/ooxEm61F4xQ+DHP/5x+N8lg9rkfmhTRjwIpQ93/fXXh/wrvaNgVLahilHcB8R0peOke5QMS467KA8mB1AecZl89dVXYc+Msi5pWu6jbo9yNNUvbGHVPV2/dKlb5GUc6TKP0LSP3LRu0UveLCJ9TOJAVxlM5eHKXKDr8jXbM7SBNgYvmHXFNEtuYhDgfqYk1k1ZVZix0vQDSnH77beH0dyuOmZMgSbfOSVVY8rTm5yBYzSccmPaN6Pl3//+92fMcMJgX3fddeEpE3EQDsoSE0/BzaHpotDvqwEYKOJldtX//b//N0wTHvSJhmiT/jbwBIK0Utc8ZWKK7qCNjBp0nu4xu4DOUb8gfxh4blAIh1mR55xzzvSgGgNspJe44o5EU11g0I4BWtMe6oYnqAzW0lHCblBPyNH/9//9f4WvenhaVgbTufuF1y2wu1dfffX0VHZelWZ6uF67ng1mW+a6aidmg7o2sAub0wTNqPj9738f9sNkmO0KDEv/Zos2+hW/rpajK3nSjA3aKyBezdLskq5schualhGz5rl5YZCYh6PDyH8Vo7INZbS5D6iTS9H0TYa5puPDluNByoPBIfoQzHjBNrPxKiR1Gw9OjJJRtkdltNGvunu6tnR1j901/d5L5hhGHpv2kdvULfdh2Hfu6wmbV9F5SDiuSN/HVYbmG0MbaNP79f0+MZNws+5IFYcddljYs/YHCpOip6lVcB1KwUyidJAtF2ZTeG0iXUNDYHT1BCtdxySOE8FXB+SOO+4I+xgUnM4cT5wwCnRCCJuON0+yco0rZcuoO9dqnQXSmuaV43hNsBwYKOLtahYgtEl/v5BWbt40u03v47fl66+/Dns603D00UeHfW5dJcqziTwCr4SSLsJhUI28kmbqmSnaDL6lTxKb6gI6RZ1hZFN4utG0I7tQ+cUvfhH08j//5/8cZqcyQM9T1SY3UdQfvPrqq2EfoyfEg8zYREbQZV6N/pu/+ZuQPuQIGzKIvuQ4+OCDw17rE1Yx2zLXRTsxapq2gV3ZnDpoG7HLPNTRE+CYLstwGO0KDFv/Zosm+kW7CrQfuKWore9KnpAX+jjExxN+HmgNi0Fscj80KSPabfp/yBxpmw1GZRvKaHIf0FQuJT9acywGe6S8dKXjPOyELmYeNWUYctxFeaDLrEeM/f+X//JfhlnGXNOk7W9L03IfZXtURlP94r+ou6dryqD32Clt+nM5Br2XzNF1HqFpH7mfusWWUX4MXGn97nEi1fdhlK/ZnqENtKnBlBCyVyXniIUV7rvvvkazMDC2DLpgbPW0hbDYUAS9MlQG/riOBQ//zb/5N9PXshFWPCpNnngNoAkMfpEudSJy/PSnPw17BnvihoLXQIlfqMMqWK8m7VBfdNFFxb8pGFGH1LiRBzrkeg2H9JFO3CmHOP8c141uayZYnF4NPlVBfqueFDRNfxu42WBqb0zbdRLifPKfhpInAupIM+uMp1VMvyUulSUb5Vk2KyMtDxlAXgeSnIBevUG20857U13QAB0dV63vx4Z/rtt3333D+VFC/E1nFVbJzbAhbmbaMJuUJ0DMTmXmZdOOsPT0lltuCXkW/KfeeKI9yIAYA9P/6T/9p/CklLSSPmwRslFGbJe5RmuxyIaXoRm02K/YHpEX1ZHyONsyN2g7UUdV29aUNAzNUCp7WCPa2pxB9Ie2Cbmg7tkrHur/iSeeKHwNBnag33YF/1V2ZNj6Vwbhx/ENQq7+muoX+QPajlQH/tf/+l/hXL9tWA4tjE17rjatayiPQWxyCvmMZShX3k3KKLd4Peeb6F8qw01kP0eXdVkGclSWJ7UhxKd9zlY2kUvkh7zQ3mh9XTb8U/+6eexHx3Np0npG6SL28f8uGZYcd2HzKG/6FuxJF2nl5rzsIUgsD8Tz3nvvhf8fffRR2FfRptxH0R5V0VS/6u7p+qGpbjWFMoQm/bkcg95L5ug6j9C0j9y0bvkfyyY6cd555xVHs0esg0C60XdeEZW+D6N8y1DZLUgmM96KSaGcWLlyJaUVPhP7hz/8IbilTFZm8DMppOEzseyXL18e3FavXh0+CwuTDWv49O+yZcumw5oU6u0+Bwyc53q2yZvBwnXqk+tLliyZTtOkAQuf6SW+SQUofG0PcZEuXZNuhLdx48bC99Snj3FL05Xy0ksvhTAppz/96U+F6/Y89NBD0/nBr/LEMenimDQSHuWhtFB2hP/kk0+G88TB9eRXkG+V96ThDP4Ij3KmzGOoH8LHL3kk74Q/2QAXPmbWO2njGEgLboRLOjlW3RMOdTmpzGEjDsKXPABpV7lSHqJp+uN0IVdKVxyuridejkkT53EjvcgO6asCP6Rf9cL1/Mcd+YtBPurKs6w8YsgX51MIK+cfmuoCaVEaKVP8cSzZpmwoN85zjvzKXeXNXuXdD5ONcggHOabuKJM4XtKleOP6RE4Ub5k7dSR3woc47ZSf/MquUF5cB3E6CEfpoHxwI5ybbrppekP22RRmFSp70kC4bPynPOI6IqzYRpTZ2hjCwS/lqbSRD9KWXo+skA7KmTIib+gD9a08YnPisojrBJQXyo60SpZV9qRD+lEnc1BWn6k7xOlqIqP9thOQa3vKyqXKnfrAPU5vakPxx540rlmzJviBsnChic0paz/L3EkDbrFexHaZjXhIS2wHSafKv84mg2SWciAfkkPcVCYc59oVKLMjSgPhKy5oon/4byNbVSgvhDMIqg82/qc00S/y10QHmshTVRnHcB3+csQy0a9ek1a5yeaxUUZsZemKyclQXXnXlVFc1uQHW0rfRfnleuQYcjoQ5zcu3zJ3yknusd7VpRN/bcq7Sd9FNL0PaCqX+FdeymQcmuq47DFxxbYP8Ke0EheyQR0SttJJevBH+KpXyTHItuI3125wjcqbPOBGWXcpx9CkPKogneQhThf5JF1puSHjpEFpJx3IOW7Uscosli/Sovy1KffYLxvywDVpe6Ty5pzKG8ra9ZwexXVMeHKv0y/gHHkkDq6jXLhG93T90ES32uZFckL6qd+q/lwO/NeVRRw3dau447rgPzTNYxv7RRi6XrLM9dQJ8cofNKlbyZyupY7xG/fdcsTl0G/bVwb+2CgfwmAj3+iFbAI0tc9d6An5wU1hLiRaDbRJidKNykpBGTHiOs+xruc4rmyEmcpVeBjqVJmpHJ3XFlcY/gkXd4QJRahrQFCENMx4I5wYwowNeI5cGeGWksuP/FJucXlwHBtkriWvpEV+cvnlWGlWOGVCTryKE/+pP8WjTXVOHCp3pRM3wuA4zrvyjP9YHuItjrdJ+tPr2XLhEqfySDixe1V9CtJC3LqWNFXJGOUgv7l0Q1oeKYShjngM8ValmXOqk6p0Er/KlnKJZUzXx1uuXNn6hfgkJ4q7abz4a+Ouso43/ObccStLB3aLhjY9x0YjQoNbJhMxxFEnS7k0sFVBOZKO3HW405DGIF/Ez6aOAfGSHvKr4zSsmFiO8Cv5y8lp7DeVubb1mUtXzi+baKobMcSVhkc8ZfG3cVf4qpsqm1EWrqAsy67P5QG3Nu6Ki/Ki3OSettfxNdq4NnUjP4BOkV7qg3iBOJRfzpE33PDDcZpvuUueyuISxIN/zuXkoKysUze2OtAr4qDzGct7G8rqKQU34uJ8ql+C8qbOFE6ZDnCtyoh9Gp+u15aWsSD/uXTkypM42pZ9FzaZ9MUy1LS868qIvq3qQ+WssCkXpSunA4o33tq4x/VRlc5+ZF154NrUxsdwTvHKr8LmmHyLpnJJmxXnJSdbQBrlj3JtquMx+Oc6nVcYqifSXCbHKqPUvSzeYchxTF15VMGNdJombaQtHlwkH8ojNkh1TtzUneJMw+Ea0aTcReo3bY/KyjtXP7m6LHOP01tnB3CjLHQtx2Vy25QmuqX44q0uL6SdcpY74bKnjONyLYPwlVfVlyiLu6wumuSRfXwdWy4eNqDckdncefXDYurqFnmL05DmOUcufVzTNi9lyF7E9jTVC2hSvmV1k7qVuRMOIBPEhY1ranfmC6G2JivFGGNMDZhLporrdb544Vde72FqNq+7D/rp9n6ZbMB611xzTXhVgfToM97A58gnb/x6L774YuWrpGa0sBTA5ZdfHl75q1pqwMxt1qxZE5aoGNa6YQuVcbfJxjRhnOWYZVdID+twffLJJzOWWvjDH/4Q1tf7/PPPCxdjxpeF0EdetGhReDX5mWeeKVzGh+XLl4d0dbn27rjjgTZjjGnIBRdcEL4WVXazzLoP//iP/zgrnWHWZDj++OMrGzFu9nMffTGzhwfa5j+sC8M6ZcNYPHyhM8422ZimjKscY7ton6pu2tXvMGacWSh95HEdaGPNTQY2WYdyITG0jyEYY8x8gg7nunXrwpPn3PMJ3J588smhLfpdB1/O5UMhufRxzJO8L7/80oNsY8awFp814wE3yHzx71e/+lXhYrpi3G2yMU0YZzm+8cYbwwBFWbpI+zC/KGxMVyyEPnL6EYRxQR82XGiDbOAZbcYY0wC+4MW0Z16RWLVqVfhK8X777RfO/c//+T9DI/4P//APs9ZIc0PPE/Gdd945pG///fcPX0Ziejyvfbz99tvhZn8hTdked+jYHXbYYeHrT9xoMVuBp5HGmHrG3SYb04RxluOrrrqqd8MNN4QvFfK1RvoVO+64Y++f/umfei+99FJor/gCqTHjznzvIzOcw4AWeVu6dGl4wLfrrrsWZ81s4YE2Y4xpCB3i2267rffcc89NfxqbBm3lypW9iy++eNYbaNZSodNL+r744ovgtmzZst4555zjV6fGDOrqqKOOKo6mYLq/Xy80pjnjbpONacI4yzGvfP33//7fw1psgnT9+3//773mpJlTzOc+8gknnDBDR4HBcC9JMrt4oM0YY4wxxhhjjDHGmA7wGm3GGGOMMcYYY4wxxnSAB9qMMcYYY4wxxhhjjOmAgQfa/ObpwoB6ns26nu34R8mgeV1IZQULLb9muEie5rpMWS+6Y7ZkoizOtu6DMqxwTTtUD/3WR9k1/YS1kBhm+fRbl6NgVOkalzIY57oYNxZaOQ1TNixz85u+B9r4hCxft9hnn316N998c+Fq5iMsHslCrHx9aLY444wzQhpYMHY+Q1lfeOGFvT/7s/5Uk/KhnigrwprvYIewQYccckjhYkx/0NmhLfvLv/zL3p//+Z8HHVq7dm1xdm4R2wHTP7MpE2V1WFW3w2gnx6H9N73e5s2bQ/0ih2wsfP3OO+8UZ6uJ++txv6DM3Uwxivucce3b8gEEZGwU93fjUAbqe5NnUw06wT0KX/FcKAxDRj2OsjDoe6Dt/vvv7z3++OPTX8cx8xs+4c02W8x2/KOAhp5PTK9bt65waQcNAJ+Bf+SRR6a/prMQWAiyYYYPnWw+7/7BBx/0tmzZEr4AeuWVVza+mR0XZAewIwvJDgyD2ZIJOuC5OixzF8OyhbaxswvydswxxwTZ++d//ufeQw891HvjjTd6N910U+GjGmTmvvvu266/XuZuphjFfc446haDbE888cR2XzAcFrNdBujXM88803ffeyGy0NqDYciox1EWCBMDsH79euY7Tqxdu7ZwMXOd2a7Lbdu2BblayCxevDjoVb+sXLkyXL9p06bCxRhTxebNm4PObNy4sXCZW+Ts9ooVKwayI12CLRqWPRpWmzUOMlFWh8OqW/fl+meYfRfa9GXLlhVH/UHdIjOpHpa5mykWwn1OTnaRh/me7xTyi22dTwxafwup/mcDj6PMfwZao22//fYr/pn5wGRj2/gJ6bDg6epXX31VHC1MBn0N8qCDDir+GWOa8Oqrr4b9jjvuGPZzickbot4LL7xQHI0fk/2M3nXXXVccdcsw26y5LBP9MA7t/1xmmH2X5557Lry2ZEbPQrjPcb97fjKoTR/3vsV8wOMo85/WA210mrWlxOfqzovYLT0H8XGZH9HGL8R+yvw18dOWpmE28Zeeq/Ifn0v9YJBZm4DXUdJzkB5D6k/HOb8Qn8/52bBhQ++KK67I+im7RuSuSYnPNfGfI76u7NrYvc4vxH6q/JXR5vo6v7F7lT/I+U2Re+4cxOfL/DU9nyO+rswPxOea+E8pu77MvYzYT5m/pn5End8y4uvKrm3iB5r4i8+V+ZN77hzE56v8xeDnyy+/nP6fXpf+j4+F3MvOQ+xe5j/nVgXrNv3t3/5t+F93XZOwm/jJEV8XX8t/Xr/kFaT0HMgt3lJi9/h/XZtVhfyXXYN7lUzkSP3UXRefL/PTlqqw4rhSP23bf/kp85tzh/hc7nwVTa5t6kfk/Mktd66Mqr6LqDpXhvzrNeGy6+Vedn4Q6sLOnYvdYncoc08p81fmDrFblb86qq4tO1fmDrFb6qfNNTl/IvaTblU0kV2oOw+xnyp/KWX+Yzf5Sf3m3GLa+K0ivjZ3fepe5rfMPabOT+xe5reJTU+3mLq+RXocI/+560TsXuc3R+y/6fV1/mL31F/VdaDzVX5EG79m7tN4oA2BiBcFZvG+p59+ujg7tb4U7iyQyMb/eHE//uvciSeeGNx4LxlDgN9dd901LDZIp1zEi3Gi9PzneuLeuHFj4WuK2C8GhnAIl6eANCQphBcvLMv/9D1pjmM/xLt+/fribH8QJmkjv4TJ7KU0L5BLH08XYuLFO1U/hEsZpQsXs7YLbgqPa9iANX3+7b/9t70333wzHMuPFsfNLYrKNVqQWXHzn7hJE3UQU1eWXH/WWWeF/6xDgh/JSRxXSk4u165du138beUjB+VPfSkP/I/rJF7YkrJj3QfiVLqo05S0nkkX4TRFeZE8ER9rCuWok/lYnhQu9UkZUaYxqV/2+KWcIVcvqe5UyaSgfBUGe+IkXBGnIyUtG+qLuiZtop86S2FBWK6RbJEn4qTc+A9KC+GWyVxd/UATm9SFrFMmcbkRJ+UT08SWUda4HXroocEPfrkmzdeo5CmFMPGLzYF/9+/+XTiW7YnLkvohXspRa3Q1zV9XMhJDmH/zN38TOtIMZHEdWw78UnaUKelIbUyT8i2jSlYoR4WjsiUeiMsBd5VFnLYyuSCMqjarjFw+0/aC85wrk4kcbdvDurakH6raSepAeWaLbUvb9h93zpM3ttgv6FzqHuuJ6jotlzIom9ju8T+1zVV5hNTWky/SQdlL5kgP9RXLc129UC5lfRdoInNlKC8Q63hcrrl2Y1BZgia2jXxJDtg4zslHTnbYVxGHoeshdlc5UH/Uv+oWe8d//CC7TdpxyNVVfJ8DbdNVJXNlOhvrnGSS8PGXaxeok1gGlA42jpWeFMKvkl3RJA396A6UlcGgbWZXMgE5HYv1gP4A6SBcZIg6R4aIC7+kRbJFHnBXHmJy8qf2E1J5Kuuv1tn0uDxxV5kSPlT1LdI0xDSxGdBWvlOIV+Wt6ylTrk/vVaBtuTbVU8iFXWbfc35T+2LmIZMV34hVq1ZNLFmyZHodh0kh5W41bJNCFdw4p/WlOJ+yevXqsNaEYM0JXTupiBPHH3/89PvxuHOesIh7+fLlwe3000+fjldpmVTs6XWpiOOCCy4Ibmykh21S6INf+MMf/jCxdOnS6bVX2HMtbvLHnmPSwH820hDH2xbiJS0qG8VBmEoLPPnkk8FN/igbxf3QQw8Ft0mDOrFmzZrgRpmR70kDFdKWS6fKXnnRtTG5dV9Il8o2rmddz6Yy5zwyglu8zoHyWVeW/I/jAfxyXLZuGWESFmUEkkvFBXEemshHDsqb65FFHafXErdklv/EQ56UpnTtB8kD/ggjrme2Ov70pz/NyD9hEJauj8u2TuaRHekW6UQXqWO2RYsWBXfVSyp7lC3x4o8wgHLiP2GzER7+161bF85DnUySJ8pH+WC/9957l6YjZsuWLTPKlk1lozqEtnWWksoWeaYscVddqmzlrvhIv+jKJqXpIT+4saXyWgZ+iUc6RbrjOKCpLSMNcbvBnmOuJQwYlTxVgUyleUzLkjjZSJfy3SR/aTj9ykgZ+MvJKW4Km/yRNumAdEg0Kd8cpLVOVnJlC5QJ5aQ8pmlrIhfKY1NiewnSc+lUTFm6UzivdLJRx6ST65EF3OL6IV+4VbUloix/qTvXER9hpP6VR+oGVEdxmiAXVyy7qhcgz4oLPymUp+ID+i2Uu+pa5UXYdXAtcakeVH64pfVYlUf8SK/ICzJEe4I8ESZlyHnlEzfO41/pLoO0KdyUNjJXRpoX0aSvKEgb7qk8l7k3sW2kX3ob1yXuKjulTSAvhFFXpkAaCCMtV8kkaSLPnJc8cg32CzeVBeealDU6GedZdZWmoUm6oErm/sf/+B8z0i1inZMtwU3lluaF/7hxDf9jGYj7OmWQVqUvRu5N09CP7nBdkzKI20bljePYXeVMfP3KBO6pntX1zYgvbqeIi3goP9Kn+HPuqW7UtcOxPPGfeiE8yWmado5xT6Fsyb/qRjpM+mJyYcZpIO4Y8lhnM9K6rZOtFNW70kYZUf5s6FUuH23KlWvxW6enguuQqSb2val9MfOL7aUmgzotqVIhNKmA8B83BCgFwZNis8dfLIj8j5Va8aYCi3LiHvslbXKL/So9cdrxkwq1wlS6FV7sTwY2vbYpxBunGZQ+8gqkHYVOG0iUGH+pEZKblBxyaccP6Y+hXGNIG9el5MID3Vgr7UA6ZJBU5k3LsiweyKUNf7jFeYecXCpswqmTjxw5f5KZ2E3+OBeTSz/ll8qD6jn1m4N8pvIAqpc4XcQTlwekMh/LmPQUVFdpXLjF8XAN5zlO/fJfYQj+V8kk6UplFP9pPgg3LUeOKYeUXNm0qbMchIW/1E6p3FJ32bU4H03qR/HE/qr0iDDjeJXPOO856ASlZcFxfB1hs8UofNkDpSO2D6D8p9fjFqeva3mqoqxslIc4fvnRuSb5k99BZKSMNC6BG+fS9KX+SVuT8s3RRFbKyjZNh+JM84JbfL3kApTHJigdTdoLKEt3GU3bw1y40vU0rrL8tXHPuSFvTfwBacI9LR+VW6pz1A1hCY4pgzRvSkPc1qTo2jRuwsdd1zbNo8pe6SN8hcG5ON0g/UTOqygrI8XXVObKiNMsVDaEFRO34/gRSktaDzl35aeJbSMO3CjvGPlN7wVwb5rvunKN06wyTctDclAXp9Kblk+urtqkS245mQPcOR+j8DlXV4eyHXGYuj7XB0opy4vcKb+6NOCWymdT3YGqMkjjb9NmtpUJ3NJ8cJz6U5nHss1xbJOA9OXcpaNxXOQ31dn4eqHyT9vdXBnm3CCNW/HEbpBzA6UhlgHVF/UQo3qJw5Ff3OL85sLNEdu4uFwlG3E5ti1XpRM/dXqqa5rY9zb2xcwvGr06etttt/UmDXbviCOOKFymOOqoo4p/33LOOef0JoW3d8sttxQuU+hVmwMOOCDsd9hhh7C/+uqrkdzwn2mZP/zhD8N/2H333cP+Rz/60Ywpmz/72c/Cnimtmuoq+AR6bnrnK6+8Evakg+uOO+64EK+273znO+E8n9oF0rdkyZLe/vvvH45Bae4HxXv22WcXLlNcdtllIf7TTz89HD///PNhuu73v//9cCz22muv3qRChnN8kj2G6a2cT4kXsaRMrrnmmhnTWc8999ziX3/svffeYa+0g9IJmhLbdVmKe++9tzfZYG6X90svvTTsc4uA1slHGXvssUfIw2677RaOqbOddtop/M/BlOYcmmrN1OxJ47ydPJAXdK0O5H7dunWh7NP8INsxTWVe5Yg8SU+BVwkoZ2TvtddeK1ynmGx8pu0C15CWO++8M8RFeSku/mMXCENlUCeTlC9T3ycbqBAGkJaqcgemeZPfyQ5e4fItWpSdNKbU1VkdqZ3SIuqpu+yaGJZN6lfWiQPZmuxkTJf7aaedFvbQ1JY99NBDYX/ssceGveA8Mk4YhBUzTHkaBNawUVkqff3kr18ZGYTYPovXX3+9+DelC03KN0edrFRB+4FdEYRVRk4u2tJPe9GGpu1h27ZkUJDF5cuXF0dT8fVTfikqtzvuuCPsBf2T2Daov/K9731vWr7Y1M6hJ2VwLTJ46qmnFi5TPPPMM73PP/98up1qm0e9toUfhUH9n3zyyTPSqDp65JFHwr4tw5S5fvqKTWlj2yhD2lraatpeQT8C0nuBBx54YLv67II999wz7M8888ywF7/4xS/C/tFHHw37Mtrc5/RDTubqaNKGv/XWW2Efh6k80McclLRtEu+9917xbzi6IwZpMweViaZ9M5H2nZW+1D21B9C2HR6kv9qm7W1KP/2hfvuoKr8m9ypty7WNnrax78O2L2Z8qR1oo+GkAVUnMiZn2BBObkow8LznLHj/Ob7pUWeATjrvKcvv+eefH/ZVEAcdb3j//ffDviny/9d//dfhnW5t6gxv2bIl7FEwBjNQXPa8V/0f/sN/COf6QZ3JuhuoJ554IuxzXzqT0qfGvQnXXnttqEfeDScv5KlJWfeDGoC4A9BlWQIGGxnLGWlkq8lNYhtoLEg7YaMTrAkwSCf5ySefDPucPOR0LYVONqgjEZO6NZX5KujUwLvvvhv2VSBndK7iuNioD/jkk0/Cvk4mabBpxOgkIVOqyzq5Vdnkbl733XffsB+089cls2WTylD5kh7kHHknbnUQmtoy2fScjqqTp7Cq6Eqeuqar/M0GKjtoWr456mSlig8++GB64Juy1I35MBh1exGTtoddtyV13HXXXdMDq+SPNYO6kEvSTz+MsMiH4AuG8WAjZU/ZpvIlG/zRRx+FfY70IVAZg+aR9JNGbG6cRuRaxHlswrBlblh9RWhr23784x+H/f333x/2QDuMfFAGusGmDHfeeefa+uwS2kvAzpVBujjf9D5nHMnJJzI2LPSV0mHozrBpIhPQRd+5KYO0w20ZRts7Lv2h9F5lWOXaxr7PB/ti+qd2oO3TTz8t/jVHT6s0MkynEiVMn2LdfffdYUFCnkzSMeKJpBrkYfHxxx+HPbMeNLodb7HhJN1r1qwJA4EgwzRM9KWzHIN8BpiO76ZNm8JI/uWXXx7yxKyqUdF1WX7zzTfFvzzDuGnDWB5//PHh6QhPIdTY9sOgHQ/JcRPayHwX0PisXr06GxebbsLqZJIGjJkLhEUDfeSRR07fpFZR9Zl63YCME+NmkygjOgXcJPEghKdwDFy1RR2ZHAcddFDxr56u5KlrusrfbNO0fHMMKis8gKO+XnrppTBAMyxmo72oosu2pAl09unkYy8YFNGDykHRzLVbb7017ImHPMWQV260crLFRj+wCwbJo/q5GzduzKaRre3g0LBlblh9RWhr2xi44MZSg6fw4osvTtcteg7MsGPmk6DOFi1atN2G+yjp5z5nXNBbQPEsZfWRqmx3VwxDd8aFUfadB2mH+6Hrtndc+0PDKtc29n0u2xczOI2/OtoGjCodRwScATaebCHMuZFfnogzur527drQYT/66KNbDUJoenJTNMslfQUuhYaKjvBzzz0X0sdrUV2MPNdNiRXxtOyUfhstZhnQMPAqHpx00klDvRFVOodVlhB3LnK0lY8yGADmZoE8UYbI8zBf9+mSpjLfBF57qoMON3XdhDqZxGZcf/31wZbwegodeWSpCWVfXwUGBMaF2bZJOZBzBjkZuELuGbhigC+mqS2rengyankaBoPmb7ZpU745mshKjgsuuCB86U435KMYBB9Ve5FD7eGo2xL6YDykYACKetJsji4g7cgPcWCfeH2I5UNimMFE3043//1QN/AyaB71Cv7vf//7sO+SYcvcMPqKoo1tU5+fuqI+GFAjfmRd8sGrevGNLeXOgGi6dbG0SMo4tfldwgQGypiJDaovluRBL/UK2zAZpu4MmzqZ6LLvXMeg7XAbhtn2jkt/SHENu1xns09h5ga1A2161YoZJW06SjLwvJfMlq4jEcPNNDeNzG5jVLzJuhKkBSPZtiNx2GGHhf2DDz4Y9il0CICGis4hI/25AcK2HH744WHPO9059MRPT6cwgClff/112A/6TjcdHYWfrq/SBWk6uy5L4IYaA4q85Ax7v/JRximnnBL2XT19P/jgg8O+3087a52uujUmoKnMV6FZYk2ewjOjgfrO1QuD6LmbpjqZpB5Jp9aCqbrxoqMOucZVNiyddTGbzJZNagJ6xo0runTDDTcEt6a2TGvkvfrqq2EfM9vy1AVd5W+26ad8c+RkpQxkmhlwN95440gG2EbdXsSk7WHXbUkV1B9vCyCr8QBHl7BUCOXKa4PEl5YhD0+hrF9X1f6whg9o/Z8Y6oxru8gjMoh88CBHbURMVRrLGLbMDbOv2I9t09qM1BXrsGmtJpaMoQxov+J19IByx2akW5c2oUmb3+99zjhAX4A+AbM50TVmBPKWEHIxDHuWMgzdGTZNZAK66Ds3pat2uA7SPIy2d1z6Q2lcwyrXNvZ9LtsXMzi1A20Ycd240lDGqDHPgXCheAg4gpg+YUS4dUMmytbTkeIIlINwzzvvvMKlORgWhJ9GgVH9WOgxQJoqTBwpVfmtA6UkXp74EW8Mx3pywtMpNVppGljXizD66Uym11AOqtcycmWQIzUcpJM8qKPVb1kSbpVRooMPqRxJPrp8rY56S0nlsg1at4cGLzXSTQzxoYceGsqYfKaNfZqupjIvcvFzLfKSdtxyfvVqCJ2+uBHDL/Gr0amTSV5BS8vmoosuKv6Vo3CwO2nZaP22YTzp7VceZssmlZGmgTYgtrVNbZnqKl0MG8grMyBGKU+DkKvbfvI3iM1oSlO7LZqWb446WclB+lKbA7m6F1XnYqryPqr2Ik1r2h523ZZUUfbKSpPybCpHWhKEmYzpB1JA+f7JT36yXdkjP1WzchU27WRsy0k/s3u5meonjzm7if2gbgg3zjttkNZDawpxsw1T5obVV4R+bBv2VrPXeJCoh0FxHfa7ZmaqH5qtnltfKa1btfnpgvgx/d7nDJKurkA+GcxkgJIBNl6How6oj36Q7LahS91J6cI29iMT0LRvJtqWW8wg7XBTqJu2bW9Mamdi+rEZg5JLN3HF9ypty7WNnja17/3aFzNPmDTKtfCJ28kGPXyCduXKleHztHyqdlJwgttk47rdJ7wBf5zPfbZW57huW/HZXfwRz6TBDsfygxvxAeeIjy2GcPBLmhQekF7c2Ys4P+y5ZtKYzvhcNGnhPG6kg2Pllz3xkRb5w60O5YeN+LiG+CcNUOFjCvKquFUWxIdfwhDkA3+4yx+oLIhD+eGYeNKy5XPIgvO4kSfSoDJXeHH5gMqDso3TmYbbtCzZcCPd+FO5ECdunFOaAHfCxJ0wgDBwi+sblC7ii/OQk48cSi9pUtoU9+rVq0OeQOHhJuL0K52g8qb+yJfClV/CoI7LkJywEb/KVukiLaqHJjIPcXi4s5GmVMaIS375n6K8sRGHyi+uP47xp3AVptJMGohXx6SFPBGekA6wxelTftmUPvYcx3UAbeosh2QrLcsyd/KFeyyLTepH1+FGXjhWubInPspA8cbhg/LJvgquIw7JHmGSlrh8VFdsnOMa0k19xkgO2JMWNv5zTZy2ODzVV4zCYSNtyncbeSqDdBAmftOyUZmT3li+RNP8dSEjZRAXfskndUQ6uSZ2F7G+qH6hSfnmaCIrslOULWkhb6obZAY3/Eg+5cbWVC4IkzCq0kuZqJ4pdyC9uKX1Hvut0xehMsO/ZEX1G9eB/JF28sRecVFu5AXiOozz1cYdN9kV0kI6SF/sT2VRVpZlMhpDmMRTBmERBhtxUwY5e5FDuqA0pLLZNI/4wx039mleOFY9sEm2CTvWlRzUN9cQp+oU4jBVzmUyV0Zcdmk6dI7wYpkjzam+KO9pmZe5Sx7Ykw82/pPHtOyEZEVpEcTBdf1AXtjIK3WLjrAp3ypXyQluyjt7ro3tURmULX4Jg/RyLXFK3uK4oEm6KCeVL/u03DiO5VSoHIk7viYOS6ieiJsyYON60l8nt1Amu23SwHnyjLuu4ZjyqUtDXRkQThx/mbvqP05vG5kgnfhli+U3lgv2hE964/irrs25kwaFF7urLtkIn7j4H5eLyj9Of1yGlI9QeJQDYbDFcSO3uClMubGBwpR8K63yL1kRio89aWLjP+GorKCNbJWBPzbyFseVlikoXWy5cuXaOO44TcBxTkZxJzzcVe7EjVuah1iOOEc9EJbSwjVx3Zn5Q6OBNkBIJBAIC8KNoCB8CEsqmCIn9MC1CJaEl43wiUfIICCUEmbCkxILpSvedG26iTQ/aZj813nSiKHBDb8cEz5gfOQm41SF8q14KccchCV/bJRBXDZqQOINt7KyIH1xeLn0Uk+4x+nKhSd0TmXAf+JIw21alqB84Z/85uoxLjPCkXHlHOHF56GsTFI3tjJIC2HjJ00bx5RdHI62XDz4F6RVaVe47MlTXN9lUJZKl8qWMAkjrQeFjV/iTGUeOEcdIm/8Z2sqeylx3nJyQXqrZFL5UBhscZpz6YhliTTH+cilIb5WW12dxag8443r27iLuvrhv86rrHDDL8dV8aZubGVQZnE4hJ+rX8JV/ZX5AdxJn/yl+crVYy4s3Lie8/3IU46ysiGusrJMqctfWTht3Ksgj8Sr/ObyRJi5co7zU1e+OZrKivzEZUO7kV6DP47pcObSm4ada7OqIG7SoHxybXpdrvzY6sJXHuvaQ/Rc8sI1HCtOjslTWR22cVd66Z8pPSp/znFMWlUfbdv/GPJIWFXgR/nOlXsVyEN8bVqmTfLI/3RLkXzofNr2VaH4VKdCYVbJXBm58meLoSxiu5dLc3yttip3QTpV7qRfZVsG54g/hfrp9yYS2VYaCJs4SBdlQ7hC5U8aY1lpWtZAuanMpQeKP73PaZIuzqWbKNPZXJ3n/LIB9Z87p43yqENlR9xxGcRbLg34E+S/re60LYM27qB81cmE/MVb7CeVi1gPyq5t404eBOdlK9L2I72OrapeytrHurZXEDduhKF0lMUlCE9lzbVxWUGurnJ5YKuC85QPcib/VTLXtlxFLm1xWUruFXZOvkQb+2LmD4v4maz0ocC0YV4nYEpzPzDNkwVuJ4UxrOE2zrD48/e+971OFxoed5gmzjvnQxQhM2JY32OyIehbZ40xZiHi9tCY2YOlJrjfmLxxDcsbLBR4BY7X0XgNktfQ3n333eJMr/fRRx+FVxxZr63fV0nnMgtVJhYCvlcxc4WhfHVU8N5ybs2O+QYDim+99daCGmQzxhhjjDHGjB4G2Rjgv/baa8NAEvcgTErQxgdXVq1aVfg2xhgzajofaNNiiTQAb7zxRt+LscJcWCTwqaeeCl9Z+fWvf124LBxyC1GauYvr0xhj+sP205jZYxQfmhk3+JIvi66XgU3io1ALcTYbLESZWAi4rTVziU4H2pjBtnTp0vCZab6K+Itf/KI40x8PFp9U1pd8xhGeIPElJX1haaHALD418Pw3cx86bbBlyxY3ZMYY0xC3h8bMHvRX+NogvPfee2G/EPjOd74T9vvss09YvobXRFlyhwkAHJ911llhtttCZKHKxELA9ypmLtHpGm0Y97/7u7/rLVmypHfHHXcM9Col71+neO2T8UDrHsTMhXX0TDlaXyjG61oYY0w1bg+NmT20lnPMQlq7ifzfeeedveeeey7MXoNly5b1zj333DAJYCGy0GViPuN7FTPXGOrHEIwxxhhjjDHGGGOMWSgM9WMIxhhjjDHGGGOMMcYsFDzQZowxxhhjjDHGGGNMB3igzRhjjDHGGGOMMcaYDuhroI2FJvnC6EKAr/iw+CILHseUuQ+CwmSrgq+aXXDBBdkPRsx1Tj/99PAxjQ8//LBwmRuQXr7yRNrNTLAVyCofS+kCvjLEl42XL19euHQHacW+jRJkBzuC7Iwi7q7row2xnrTJK2mlvkk3G/bPX5v6FsqCekUvmpbroHIwDJtXFeZcbRsWOrNpb2aTfnTSGGOMMfOH1gNtDAZ98sknC+JrNnQMn3jiie2+cFLmPgiU60svvVQbJoNsv/nNb3rr1q0rXMxsw40fn5umTvTVJzM3wa5h37jZHwXcjCE7N91007yXHekJn9xvk1ds409/+tPwxbBt27aFLzqia/rEu5n63P19993X27p1a+EyXCS3Xdq8YYRpzGwxap00xhhjzJjBV0ebsmHDhomVK1cWR+PD5I1X8a97Nm3axFdZt4ujzH0QNm/eHMJcsWJF4VIO/lpW31gxecM8sX79+uJoduhabqi3uVwnw9SjfkHP2EYNdm6U5SHZaZrXcayrplC2bfK6ePHiidWrVxdHpgxkoqxchyUvw7B5c92OGiOqdNIYY4wx85vGM9qYSXXGGWf0brjhhsJlPOApOLNB5gMHHHBA8W/+c//99/e++uqr4mj0zCe56YJxLY/rrruu+Dda7rrrrlAe4/jKz1yX3YMOOqj4Vw/tDrObdtppp8LFtAUZfuGFF4ojY4wxxhhjzLBpPNB2+eWX91auXNnba6+9CpfZhxtO1jPzayZzC14FQ55mC8vNTMa1PFiHq8vXs9uwyy67hDWhzj777MJlPFhosvvNN98U/0w/MFD5gx/8oDgyxhhjjDHGjIJGA208EeeG9+ijjy5ctofBEy1WzYLFucWqOcad8/jDP9fF4CdeQJYbBW4s8Y8bx8B6P4ceemjvzTffDMecZ+OadEFl/nOOuEWTtPRLvHA34RN/WhaQ+uvnwwqEq7ymcanc4i0mdi+buZOWpRZt55pcHeOfAQqFS51Rn4LrmRkJDLbhh3RCGldMrr7iNHN+ULmpgvBJO2EpzKr6om7ll3S0LSdAHrmWeEg/fsi/8kKaJT9saZkI4krLjvTpXF151MlzVTrTeonBPU4T5SE/hKd1CI888sjgR+WNH/KDn5SqvAquV92wx3+uLo866qiwvk56fVsIO46P41QeYlRe+KdMyBPU1RXn62SqrD7SMiWNKkPqO4Vw0nKOwxOpP8J/++23i7PlEBb+qXuQrWCDOt2AVG5Jh8pS4D/Od1r2qqe68kghHl0D5EdpYa90kkbFRxoUH/9xk7uI3Qm/CsKmzWZQlvZb10ETOVDdcQ35qIsvJq33MvloCuWZaxtiOUjTm2vPm6SriR6l5aR6ycUJ+InLG3+kgfg5Jz9NyixNX7pxTVpe/Occ4QtkMA6H/1wXQ5rj9OAnThP+lXf8cT6OI813ShMdbVvHOYhb8SgvaXraxMN5la/8cIx7FSqreIuJ3ZW+ujqALurSGGOMMR1TvEJayapVqyrXmeD8smXLJiZvSsMxa2/hHzfBOdbawS/rc7EpXPaCa7kOd/5zjngVJuu3xKTruRAu62IQF+78JwyO2aBpWoC4FU5MmTvr2JF+1lsD1hbCX7q2Hf5w1zplhKc0p3nMgT+FS5qJR9crrjhfS5cuDccxHHNOaU0hTUo/G/8JLy7fOK2ERzzkn/9sqkvCErmyw28cbozCkX/SSzz4U9oHlZsqFD9h8h+0zlS8dpTCpG5JK/Gr/NO81pXTxo0bZ8RB2AqfPGk9P8IHjik7NqUR5C45U9xcSxyirDzq5LkunWxp3oDrSIdshvQh9kOZpW6kQ2kgnpgmeZXuK0z2+InrR3COa1XG/UDe2XK2Ma4nlRl7ypP0KO3sc35jlFeFy5Yr91x9pGXKf+qD87kwFLbKjOuVVskJyB8b+edY+pCGWQZ+8BvXT53MAe5pPXPMpjTm8k08+I3Dz7krnhzkE//EhV/KknxzPe64USY5d8IX5BM30hYjGeKaGIVBeDFlYaR1S3qUP5Wp8o8bWxonfnCPaSofZaRhpuUpUjmgLHFjU11zrWiSLvzU6VEqN6RBch3XX0xc3sSPvzjuJmkD/JEvruc/eqVwSYP8xOXFf86pTEDhU1YgWcON6+XGcZWNjtOMP8mNyMmZoAxJj9zZK43KM2loU8c5CIvrVT4cp9e2jQe/uCmd+OdalYXgOM47YchvXNaCY87F+a+rA/x2UZfGGGOM6Zbt76wzqKOUdgqAhjptsPFHJ4SGXdD5io8Fbun16pzQ4YlJO+CQcwO5x51AdTLapEX5SztQOXflO74eVH7qPJGOXJjq/JC+OvAXhwmES/y4Kw1KE1sKnS86jHWoXEifyMWVKxN1+mK3nD+Rq0/8pWWicOP04w+3QeQmB+GS11j+lQd13kFhxuUEuMXpb1tOcdy4gfKqYyDfqRvxxnGDro3TmSuPpvJclU7IpZV6S+uJ47rrBO5pvprkVTd+MZQ9/nIoX/2guGV3RO6mTOVP+mJU1jm/MaqD2F9OpkDpSssVN/IapzcXLv/Tcs7pI/mMZULk7GwZufhB7jmZ07lUDznGPU27woltKWHm3GW70zByqJ7SdKhOU3eVS0wurrIyqarXXHpz/pW/NN+q37Q+lceYpvJRRi5MyLmrLDgXpyuXtybpypVtmR7hFsdBeaWyHqM0KQ34VRk3SRvIxsd1ozSnfRqVl9JN3Uq3OZfmR2HLBtXZaNKA/zjP/E/zoXzHdaE0N9FR+cWtro5z5Pwpr7k0NYlH/gT+UzfIXYtf9IgthTqP67uuDoA4iSdG+Wtal8YYY4zpnkavjupVJdYtSrnzzjt7kx283hFHHFG4TPn7/PPPe1u2bAnHTGHn1ZXJxj4cx2ixc8JJOeGEE4p/M2kz3f2yyy4Le9aWY+s3LU3gc+4QlwVQPqD1pvgQAJx66qlhLw455JDiX3PiDyiQvxtvvDH8f/rpp8OeurjiiivC60Pp6w8PPvhg78c//nFxVA6vfQCvGgjimryRDv8V1w477NCb7Dz29t9//3AMO+64Y/Gvf1j4/Yc//GFxNMVf/MVfhP0jjzwS9jFdyE0M8ZP3WP6p40n96d19992Fy7fE5SRef/314l/7cqL+FLdka4899ghh7LbbbuEY0gXjeZ0EmUvXGUMnSHsunTFN5Vnk0lnGkiVLwquheoUOTjvttOJfe5rmlTLCnsW6cOKJJ1Yutt/vemj33ntvb9myZduta3nppZeGfe6DBvvtt1/xb4r77rsv7B999NGwL6Mr3cMGpemFeDH9JvrIK1TUb6o3cNxxxxX/Bicncw899FDYH3vssWEvSAuyi5zEcgfkO7alCjN1z5VNHameKezUXXZ2NlH+0nyjI8gyuvDaa68Vrnna2usuOOaYY7aTM3jllVeKf83S1VaPVqxYMS13lFcuDSlXXXVV2ONXZdy0zN56662wj+tG8W/dujXsU9I+kGwlaY+hTYHHH3887OtsNGUFV199ddgDeUrzkaMfHW1SxzmatJUxTeIhjQcffHBx9K1ONwG/TftkdXXQVV0aY4wxpnsafwyhDDqBdTcIzz//fNjnOjf77rtv2A+rA54yzLTQiaHzpHUytCm8jz76KOx1nN609XMTl6IbdXXI4ZxzzgkdTXXwgQHH5557LtxA9YsGtOLOPwOshMmNNmudDLqYPOmkTH/yk5/MKNMDDzyw8DHlZ1gwOEf8e+65Z+HSH4QhuignbkgIA5kh/6wnkw7c0AGH3XffPezb0lSe++H8888Pe+pR6/JQLnUDdGU0zSs3dgwYsE4g6+Vo8FXpKaPtIC1lx41v7gaMOkMfKdu6cHVDrYcdZQxD93I01UfZ2ZzeDKpLdejmNVf21D1IXkxzfvSjH4X9u+++G/Y5msrHqGmarlHpUUw/ZZYrQ2xKE95///2wJ/w4PuIHPSCts9HYMR62MYBDH1B6V2dLYZQ62qStbAtldP3114f/5IU1z9rQtE9WVwdd1aUxxhhjumfggbYmfPXVV8W/7aGxHyXDTAudFzqJzKDJbZr9VPbkeVjQmaWzSbzq4DJbSTPSuoSbExYF3meffcKxZgn2y6effhr2GzduzJYpWxcDlKOmi3JC3hgsYoYQC/d3XZ9N5bkf0DUGj3gSz40aMwS4qR026MIzzzzTW716dbiRY7F9dIP66JK6r2X2M3u1jq51L0dTffz444+Dv9mAQYsyDjrooOKfGQbjaq/bpGsUehTTJm2aLRbPkJbtwo41Qbq5bdu2bFwanGlio2kD1q9fHwayeHjBgFM8a6qMUevoMNpKfVzgpZdemp553JSmfbK6OuiyLo0xxhjTLZ0MtDV98lj1tTka/lEyjLTsvPPOoTPT9U17P6Q3M3pdTU9Qea2Np6pdEN+g0JnlqewHH3wQXlnpdzaV0Ospv//978N+tohfnRuULsqJmxkGwSh7OtN02steh6l7taaMYcszaWfQa9OmTSEvfFmSG9xBaJJXbnKYjcBNDq+QM0OP+qii3yf/8Q1xjvh1pirqbNIwdC/HuOhjE6pu+PVqlWlPVdmNq3w0Tdeo9CimTZmx3AS2knZc8s2rm8yOUhtfh9qJuleAoYmNZrYUZbV27drQXvClWwa2mjAKHW3TVjaFWWFXXnll78UXXwyDjf08pG3aJ6uqg67r0hhjjDHd0WigjUYZcp0nrQ2hp3IxvBZFJ0d+6Lym6Ca+y3V7qhhmWuhggta2SlEZqTz5tH3XfP3112HPU9sYOlk8LWVwgU4iHXPcBiGNiw4/HW2e7uZeCekHOrCklcGQ3IBPTu66RAMsDCbn5J+n2m3popxOOeWUsK+aVXb44YeHPR34HHVpbyrPg0IZcwPAYNINN9xQuLajn7wi/+SBwTbqo+w1zqavZMWQJ65j5kbuZhJZJr91OtjUJg1D93I01UetcVW3ttww0Pqbr776atjHaEbzMGYUznealN1s2+symqZrVHoU06bMSBNp41VN7DOvCTKbjAGfpu35YYcdFvasB5YjV0d1Npp0MSjJ7DZsXlmbIUapo03ayjZQPswKYz1c6q5f2vbJcnUwjLo0xhhjTDc0GmjTTZ5ecYjR+iV0FOIbSv5ffPHFoSPCxgAXHbC04ddaPk2fxtaRDoakHddhpkUL+7I+RnpjT/noybjWurnmmmtmpC/XyW7LHXfcEQbycq+RaJ0OOomXXHJJ+N+GNH1PPvlk6Bwq37mBKA3GVUG4VXnXKxbMNIjjQMaeeOKJ4mgwcmkXep2Dm4M4nchPbhCljrbllHvdmfJISf3RoaYzrY58DMdVT/VJY1N5Frl0lsH1cVlyo3beeecVR3mq6qhpXnldJq2ziy66qPg3E/nrd+CdBa8hLTvywc18k1fS+HAKOlZlkwivrUwNQhN9PPTQQ0O6yWdqZ9vISR25sFSft9xyS9jHMJiBPqc3tFX2Z1AGDTu9/r333gv7ftdIrNIjkUszZUfbWTegMwp73Q9N0tVWj/qp21x4TcuM43PPPTcMlDDAxuuB6FfVgE+aRvxiK6nP1A4Tll5HrLPRPJhIbVuT9dmgHx3tF8o1ZRAblHstvh85gLo+WV0ddFWXwHnqtN+8GGOMMSZhsqNWiz7jrk+Fp0x2vsN5Nv4vW7YsfLo8/gQ9/3Fj0yfF2XOchrty5coQVvw5cj6JPtmh2C4dkx2y4Mbnzfk0PNtkx2rab/rZc2iTFo4JhzyRBlHmrs/Ts5EGyoNwSafAP9fp+o0bN4ZNecE/6Y7DTcEPfrmG/OKX/7jH5Z6i9FSFnaL6pV6IC5R/0i1Is/JEeXKsa9lzDdez4Ub54E9lQ5pUb/Fn/+PyUlgcp3kdVG7KIAyVN3viJ0zSoHKM44nLhPThxqa0Ni0n+SNclbuQf/KhMlQZkX+uBc7hpnC4jjyozEVZebCvu74qnaB6ia8hHNKrMuE6ro/rTnFzPWWqPMVlGsfXJK+EgZvqiHojfNKSgh/Cysk4YddB2KoTyR7pxY04Y1RGcZlIx1LZzNWV0sX1VTIFufpQmVI2cZkqDZRnLOvKl8LnmGuVdohlh/QoXbpW9VqF8hrHD8pvmczpOvZcx8b/NJwyWaqTsbScUoiDuPAb11+ZO2HJPS4T1ZXKD/1QnZAG3JWfXL1CHC7XK91l/nFjU9hs+EnzXJXHJvKRoyrMnLvKgjjwI5Q39qJJuiRXuFfpkeSAjf91EHecpjit0CRtQD1wXjaejTSRhthfLE/4ScEvYXOePfHhnziVNqVB4SpM2WiVAfHrGuIivFhOyuRMeWHP9Wz8Jw6FB23qOAfXKR7SzF5lrXKEpvEo3+QTnUIe5Udu0mG5E2cZxMd1cZyirg6gi7oE0liXVmOMMcY0p9FAG9BQl3VoaMxpsNXY41cNegxu6niw0fDHNxWgc/Gmjk28EQeow0DcdJiq/MY0SQvXxeGwEX6ZuyAc0oQ7+1xHlzJTx4aN/7gpH3FHNQd+8ad4uE5hVEFnsm1HSvmN6zhXXsQtv6SL88oTx3EZkXb84Z+6yNVbXG6EE5cXdRfLWHydtipZSOWmDvzH8hKXdVk8ymO84bdJOel8eq0g7/jFPS1DjmP5wZ364lxZfqvKo0qe69KZnsM/UJbxtWXpkh+Vd1mZirq8ckyYnNP1ZXqDO/mNkQ7gnsp/DsIlHMWXll8MN2xKO1sq4yJXV01kChS2Nq7JlanKKXVXOMqX3MvSmsoOxwq7rvwUdrxxXVW6YohHcVMOaT2X5buNey5e3FJ/pLmNO3EBda38IhvSc/IVD3Ck17MJyjmV2dQvcQiOiSu2d2n9luVFNJWPmLblo3KJt5xfNlGXLs4rXJUXbrEelclHFal/tpQmZUZ64jDSjevr6kYQtvKa0w/ij8sYP3E+iQc5kY4pnjjNco/PxxCers+lIY5fW10dp5AexaH0KQyOYx2Lt6p4aAf4H5cJYXCMXkJ6HVuOqj5ZXR2IQesSaH84Fw9kG2OMMaZ/FvEz2bjWwisLfBp8slPS2ZR+M3p4RYXXNnjVrim8zsIaZQ1FxZg5D6/P8NXB3/3ud1ldYRHp733ve70TTzyxcDFmfsC6X5M35eH1RDNeYJdYR+7MM88Mr6C+++67xZmpV4l5XZD12qpeJTXjRT99MmOMMcaMP40H2oBOHOuFsDdzD9Z+Yb0pffK9KR5oMwsN1nIDFvhO4aEDX2zzQISZj3igbTxhkI22mHphja0cPAA47bTTPNA2R+i3T2aMMcaY8afRxxAET95OPvnksLCqmRvQOdfitnwJrMkC7Cm63piFAA8SWCw7N8jGl4L5Ut6vf/3rwsWY+YNt/fhC+83HRcqg7vjIkwfZxpsu+mTGGGOMGX9azWgTfJnok08+CQNvZrxZsmRJ6HwzQ4HO3RtvvFGcaYZeGYbNmze7E2/mNQykgV8JNQsRviLJV4aXLl3ae+2110pnTpnRg2066aSTwtd8V61a1fvud78bvvzMK6S///3ve2+99VZ4AOA6G28G7ZMZY4wxZm7QakabYC0JD7LNDQ499NDwKhA3Tm1fBeL1ub/+678O17PxX6/UGTMfYYDNg2xmIXLCCSeEARxsPa+0/Yt/8S/CQzUzHmCXNm3aFAZo1q9fH9ZpO+qoo3p///d/39tjjz0qXyk148MgfTJjjDHGzB36mtFmjDHGGGOMMcYYY4yZSV8z2owxxhhjjDHGGGOMMTPxQJsxxhhjjDHGGGOMMR3ggTZjjDHGGGOMMcYYYzrAA23GGGOMMcYYY4wxxnSAB9qMMcYYY4wxxhhjjOkAD7QZY4wxxhhjjDHGGNMBHmgzxhhjjDHGGGOMMaYDPNBmjDHGGGOMMcYYY0wHeKDNGGOMMcYYY4wxxpgO8ECbMcYYY4wxxhhjjDEd4IE2Y4wxxhhjjDHGGGM6wANtxhhjjDHGGGOMMcZ0gAfajDHGGGOMMcYYY4zpAA+0GWOMMcYYY4wxxhjTAR5oM8YYY4wxxhhjjDGmAzzQZowxxhhjjDHGGGNMB3igzRhjjDHGGGOMMcaYDvBAmzHGGGOMMcYYY4wxHeCBNmOMMcYYY4wxxhhjOsADbcYYY4wxxhhjjDHGdIAH2owxxhhjjDHGGGOM6QAPtBljjDHGGGOMMcYY0wEeaDPGGGOMMcYYY4wxpgM80GaMMcYYY4wxxhhjTAcsmpik+J9l0aJFxT9jjDHGGGOMMcYYYwzkhtQ8o80YY4wxxhhjjDHGmA6ondFmjDHGGGOMMcYYY4ypxzPajDHGGGOMMcYYY4zpAA+0GWOMMcYYY4wxxhjTAR5oM8YYY4wxxhhjjDGmAzzQZowxxhhjjDHGGGNMB3igzRhjjDHGGGOMMcaYDvBAmzFmXnPBBRf0lixZ0vvss88KF2OMMcaYbth77717xx9/fHE0Gt55553Qt7n55psLF2PMfMf3NHOLzgbaaGQWLVq03RY3AB9++GHl+a5QWl5++eXCpRlxugijChrU2L8xZjDQ11in4g19pHHBhrRl8eLFxT9jzFwgZwO00cGk/V2zZk1f9sAYM96g1+h3fF+Bzj/88MPh5vKee+4pfI4Ps9HP2GGHHYp/xsx/GC+I+wLptnz58t7pp58e7MR8xvc0c4yJDlm1atUEQWorY8OGDeH8pk2bCpfuIEzFT3raomuXLl1auJSDH/k3xnTD6tWrg06xh23btk2sX78+uE02MBObN28O7saY+cvGjRuz7Sv6r74G9oD+hDFmfqD7gxUrVgQbIND7tWvXTp+bTdQ3GSX0g8i/MQsZ9AD9xw7E+oA7tkP35fjBzZjZptNXR+++++7epJAXR1OjzzkeeOCB3qSC9I444ojCpTsIU2k488wzw94YM3c44YQTwn6nnXYK+1122aV3/vnn9yY7t70vvviid+ONNwZ3Y8z85cQTTyz+zeSAAw4IfY3JTnWwB2eccUbr2evGmPGDmSjo88qVK3vPPPPMDBuA3l922WVB72cTbM1bb71VHI2O+++/v/hnzMKF+4FjjjmmOPoW3JnN9tprr/WWLVvWe/bZZ3tnnXVWcdaY2aPzNdquu+664l+vd++99xb/voUp4Vu2bAkN5rAg/ImJiaEM5BljZgcNwD3yyCNhb4xZuNCp5oEdnH322WFvjJmb8Eooy0PADTfcEPY50PvZ0nfSOBtxsxbb5ZdfXhwZY8pgwI1Bel6vZLBtvr9GasafzgfaaATF1q1bt3vSfOutt/bOO++84mgm6bpnanRFug4c4If/nEvXeEpn1KXvd9etw4aCNvWbEuclzUe8Vh3nSLeNgTHVvPLKK2HP0yrx1FNPzbAL2B86pQLdQsdY10mkbtgF/rNZD42ZO5xzzjlhT18DvZcd0Bb3P2J3wL/aaWwI/9VnwK5gI7AnGgCQv9hG8B8/XJv6i+0QcJ51p7Az+GE9mTh9IFvEefaEx3XGzHcee+yxMEN1xYoVvb322qtwzRPfZwD6ij7FehOv39imzY/7FIQpPSW8ffbZJ9gabuA5j95DbAcAnZUbccW2hvBS21Cl96TnwAMPDP8ZbMMP/jnPWnWEx3EM55RfxRnnM702Tp9smTFzFQbbVq1aFf4/8cQTYS+Qe+k3e633iMw31dlY33EnHHRNNgd7wTVcizvtfqxTZTZGxPaAOPArUlsW06UdNB0y9QZpt2gdBbZ0LYWyKGO/8Tpr6ZoE8bporNMSxzXZAE6v78AWX0vYuAn5yaVPm9Z407XEHROnJUbupEV5ideL47zCUnrZG2O+1f9YZ9AP1mPCXeu2yB/rt8XHK1euDMeA27Jly4K7iN2wEdJTuWFHjDGzD/oY626OuL1Fd6XH8fpOgI7jV+u28F99BF3HMefll7Yfe8KaTFo7UmHLH8dcy3nc2bBVauMFfmSr4nTK3qgvozUodaxrjJnPoGfIu3SyKegH+oYuAnuO2aRbuEnfCL+szWfPcRqWjoHz8X1DbAfkTjjYAdywC8RDvMpjnLYmeq/w47Lhevyk7qQH20P/if9s/McfaYH4Wtk34pBb3PcyZtyQjsRyn4KO4yduh5HznF6o79BEZ7lO+ig/bMSjMHDnP6Q6hTvHsinsYxtDWhQW6HqBP9mtGPzF4Sjc2NbE15LmMjtouqW6B9snEiRtqjwJZIoUgo1Kj69PB8IQQJ3jOkCApUxxWIorDk9ucTgxclN4QJrkrjghFwbhp246Jh1xWggXCDMO15iFjPQN/Yp1DFtAIybUKMYfR8BPajM4xl+M3Gg0hWyH9NIYM7ugj6nupkiX1bbLfqR9DY7pjAr8xPaEtjm+hnCxP7F9kc2hYyrSY1AHXmBbUj8KSx1wOvd0imM4n+bDmPlIqsdNUH861mtQWy7dgiZtvmxH6ifuE3CesFJy7nKLw0PPcWev4zq9L7NpOXfynIYH6ktRZqBrlQ6Bv1z+jBkXkPecPsRIvtlAtiLWRf7jhswLjut0FtLrBG5xvwLigSylq8zGkKdcfyKG9BGG6NoOmm7p/NVRYNr3ZGUWR1OviwJrtp166qnhf8whhxxS/Ov1dtttt+JfPZo+zsLIrMtWBumZFP7wf4899gj7fnnppZeKf3leeOGFsFd8Ma+//vqMtBx55JFhWij5UF6MMVPwirnWW2RLF0fmP+4sksy0Z3SJVzrawBRzsfvuuxf/jDFzBbX9attZm3XlypW9m266acZrE48++uiM/sdkp7n3d3/3d8F28FoHbXO6diyvbGBfBDaH9vvNN98sXKaI7Qjsueeexb8peH2Fa3ilQ9tJJ50UzimN119/fe/zzz+ffq0rfl3EGLM9zz//fNjvt99+YS/oTy9evLi3bt26wuVbqtp8bMfkTW7oS/AaFhDWIOs9s3B7HKded9cHFbrWe+xZfE8lfv7zn4c9r+jG6KNTwnbHzAc++eSTsNf9tmzFrrvuOt0G8x+2bt0a9qJOZ0WqK7xGSli07XFbr/7Cp59+Wmtj6KMQBm56XZUxjiq6toOmW4Yy0AZXXXVV8a8XKhnjf9xxx2XXXsBNN9MMyuUGqQZFN+yA4KeK1RXq9BO+lEx8/PHHYR8PCmqth/iGwBjTDK11wAD42rVrZwzwG2PmN9ycqi2Pby5ZTJ31nvSQj/4Ha5fEnUtucOnA0ldh7SXWK4nXUSmjnxvRL7/8Mtgm9XPijQcIgjQceuihva+++qr33HPPFa7GzH8OPvjgsP/oo4/CvgnoSRm5waYmoI8/+tGPwiA8uo7t6JLcPVCXeo/dy5HehBszn/njH/8Y9ow7gGxFrg1mqyKnszm++eabsN+0aVM2Dg2mVdkY4mJgbsmSJWFtRgbk4vXbcgzDDpruGNpAGwIVD5jxye4zzzyzONoeGhoNOA1jEAxBJXzSgcD3O5iXPqmuIlWy+Gk5x6uKxRpBxsAY0wwaJ54c/fa3vw03zPHME2PM/Of+++8Pewax4s4w/2lfecjHU2EG0y699NLi7LfwxJcHX9gPZsCdddZZxZlqeErchp133nnGA7YYdbJZpJhZ/6+99lroKzTt3BszH9CsEfShyYB3zHvvvVf8m0lbPQUG49G/Dz74IMyq556B+5OuwSbAMPSet2fKSGewGTPfwH5oFpfGHST3uUktTQfTpbNl7LDDDmGv2XQxxKsBszobgw2gT8JYCHHy9lvdYBt0aQdNdwxtoA2uu+664t9UR7hs+jVCrk9X0yFmemWXIOAIKjDrBdoM5sVKk3v1NSYeMIsVg/9xhxpQpA0bNoT/wxhcNGYuU/WUBh544IHQgHiAzZiFh/oN2AC16zEaWDv66KPDqxrpDSxfAhMMuNEep6+epzesdOBxw38bSANtvNp+wSCg7Bw3BqQznnVnzEIB/eR1bmZkXX311YXr9qCD+lKg+uO33HJL2Megp1dccUVx1Az66XqdSzfDDNhrSZh+ePvtt4t/U+i+4OSTTw77rvWe9FKG6eABN+HYyrp7GGPmMtgHZoGhA+iCxh0OO+ywsGdZiXggn/+a/SbqdLYM7kXQMdp5vfYpmF1PWupsDANuSh82ET1mYtArr7wS3HJ0bQdNtwx1oC3ujJ599tnFv+1J1z3LjQYPQtpZRnDrXjGjU6yRb27ogc583dOm+Kl5nOeHHnpoujxoWDV6rXej/cqbMVM8/fTTYf/II4/MaBBTeNJDY4ou0Xhx48ysEfSdhgz95XqFETd8OTc9Dapq0Iwxo0Gd0RR0lo4sT4Hp1L744ovZwfb4xv2iiy4qXL+F10u5YZeNYB21dKY718af/9cAwLXXXhv2siPYHf0HddTVQacjzM00bT+vsGKzsFcMFJ5//vnBD3nhtTH6J+RdA4F0wNObZmPmI7zOrZmoWsNIesUePUAHddMsHdcgNn7Y+I8ua5YcKJy6Np/XuWR76EOgk3G/Hz1WH0MD57pXSO0AcL3sAP4uvvji0N/X/UATvd93333DnnUm8aP7B90rxQMD3IPoZl/xsr/yyivDwwQN6H399ddhH19L2tWHSvNhzDiAXOYGvnFHX3gFm1cvsSPIu6CPgBvn8IOeoUfYmdhOQJ3OSt/RE/0XxEm/gYdr6KDi+P73v1/4qLcx+JedIh3YN61BSz6lm/IzDDtoOmRiyEwKdvbLHDGTwhG+eKGNL2Dw5Q0dTwp48Ec4sT82rhXxV0a0EQ7E15Km1K/gP2HG8bORphjSFJ9nE2l+2OJ0En8cfl35GLMQyOkvm3Q4ha8BSq/RR3RssrEJX9ySvqZhldmIVJ9lc4wxoyfWxXRDv9FPvrAVfzkrh2xEDtzjfgGf8Y/baeKYvKkO7XXOT86WVPVBSCthkX7cCSv98pfOYcc4R/ykMf7yqTHzHfQI/ZA+sKELZTqPu3SZa9Cz2J/C0FbW5hMv8She9tJFIT2VXuZ0XvCffCiuqvA4X6X3nMMPYeEnvoeQu8BGEa/OEV78JcT0WrYye2bMuJCT23hDznV/XwZhyFbgP21bca/S2SZ6gq4RNueIKx4/wC/npPNp+Klt4vr4a6Jy1xbH3ZUdNN2yiJ/JwjXGGGOMmTfw1Pq73/1u61c9gafKEH+swBhjmsK60JM3s+H1MGPM+GOdNV0z1FdHjTHGGGNGDa9I8Pp5P4NsxhhjjDHGDIIH2owxxhgz52GNFp5I88n8ffbZZ8YHmdrAIB1rFfFxBK1pYowxTdEaSKyrZowZf6yzZhh4oM0YY4wxcx4WDV+8eOpT9ixK3M9sNhYf3nXXXcPCwsB/LT5ujDF1YC8OPPDA8J/F1xn81+LqxpjxwzprhoXXaDPGGGOMMcYYY4wxpgM8o80YY4wxxhhjjDHGmA7wQJsxxhhjjDHGGGOMMR3ggTZjjDHGGGOMMcYYYzrAA23GGGOMMcYYY4wxxnSAB9qMMQPz1FNPhc1MwdeK7rnnnuLIGNOUzz77LOjOhx9+WLgsbCgHvohGuRhjtuedd95xexthm2FMnvnav1izZo37TGOKB9qMMQOBgf/66697J554YuEyHOhMH3/88eGz22wXXHBBq4YFv7pWG+Gl0Ajvvffe0+eJN4VBRflZsmTJdp3aI444onfYYYeFNBpjmoGuXXjhhb1TTz21t9deexWuwwM9RsfR36ag5+i1bMjpp59eaocYcF++fHnwh73IPYzgeoWVbqSLcjjnnHNCufjG2ZiZPPzww73f/OY3vfPPP79wGS792AxoYgvoS6Q2QBvX58Ade6T+CMe2GcZszyj7F/F9BFtZPwE7Ir0vswtQ5+/666/v3Xrrrdn7FTPLTBhjTJ+sX79+YvXq1cXR8Ni6devE4sWLJ1atWjWxdu3aiRUrVkxgvnDbtm1b4asaruW6eNu0aVNxdgrCJky5cw3HxC82btwY3Mg3/pcuXRrSQngpnCcMY0w16PGyZctm6NowwXatXLky6C562hT0fMOGDcFGcB3Xk+4UznOOeIBrOMZ+CPKK/ZAtiTf8bt68ufA5FR7xNLV3xsx30I+c7g2Lfm1GE1uAG3lJ7YD6IDmwG4SDTSKs1DbYZhgzxSj7F+h5fB9B3OgxbX2si7jFaeI69BlbENPUH2ETR9xvMLOPB9qMMX2B0cfYj6ITR0OTNh7q8KrzWgVpxX8Vyk/agabhigfR+B/nWY0b1+YaOM7FHWpjzPag46MYtI/RDXCq82XgP9Vx0p3T/dRuAH7pgMt+YLty9hN7wfUps1FGxowrs9G2trUZ0MQWlIWHvuM3RXYnvdlOsc0wZrR6wKBYGpfuLzT4ht3K9RuwE7FdaOpPaMDejA9+ddQY0xeTDUlv0tj3dtlll8JleOy55569Aw44oDia4oYbbgj7r776KuyrIK2PPPJIeOWDV01y3H///WFPnmKOO+643rPPPhumfbOdffbZM/LM/+uuuy78/+abb8I+ZuXKlb2f/vSnxZExJoXXHdatW9c74YQTCpfxhFfCUzuEbYLdd9897IHXOiY71r0f/vCHhcsURx11VO+LL77oPf/88+GY191y9vPJJ58MdiPl+9//frB7Za+qGrNQ4NUsdGzYS1YMSlNbcNlll4V9Cv0W9D6G18iwl+vXrw+vpFVhm2EWOrPRv3jrrbeKf1Po3mC33XYLe9p4SPsT3F9gFx577LFw3NSfOPbYY3tvvvlm6X2OGT0eaDPGtIZOGx3AY445pnCZQguNshYJnUEaOAa3WFeAvdYL4ZzWLqjbWHMk1wnVGgs77bRT2JdBWr/88svwnwGzM844I6Qv7Xg+99xzYV92I/3666+HOHMdW91k77DDDmEf893vfjd0tMvWWDFmoYPNAAayYugsom+yHVobjTVKtBYJepXajLINu9M1L7zwQm/t2rUzBsx+//vfh/1+++0X9kJ24qWXXgr7Msg3ayyl/NVf/VXYp51rYxYat9xyy3YPxaCJzWjb/xiEQWyB0hsPJtJvufzyy3tLly5ttC6dbYZZ6Iy6f3HuueeGew3CJlw2dHbDhg3T9y26/+BcjOzCxx9/HPZN/Qn6IdiGBx54oHAxs40H2owxrWHQCfbff/+wF5pdxhOVt99+OyxSfNVVV4UnrzQ8V199dTjPwNnE1KvrtVvaOAqeFC9evDgsbFoFDdszzzwTwtq0aVPonJM+ZozEjRduVaQNWszTTz8dwk0H6UANIn6MMdvDIPeyZcuKoynQTXSHAX3+33777WF2xsaNG3uff/5575RTTgn+sA+pzSjbymaN9AMdcDrokIabPs1OSQf5Y7BrdJRzizXL7dFHHw17YxYi6A8Prw4++ODCZYqmNqOL/kdTBrEFv5nsP6UzWzVgxkz79KMscX9G2GaYhc6o+xcMgK9atSqEfeihh4YPMHAfhI4K2S7NaE3BvkFTfzEMFHK/lbMHZvR4oM0Y0xoNOu24445hL+jU6cktN4t8CYeGioaH46pOZVsefPDB3o033ph99aoM0sKgG40gA2tdPOWlMaNBZVZLjn333Tfs6zrcxixU6CymesxxfJOLLWFmBxsd1lwHc1Tw5PrII48MnVm2eLbuoPCqCE/Ey+CGoe6hgDHzmU8//TTs09ns42wz+oF+xWmnnVYcTcEMWmCm/aWXXhpu8HmQiV8N/KfYZpiFzGz0L+6+++7w8J1w0M333nuvODMFM9aZKMBguWbNMovuzjvvDP8POuigsG/qL0aDc++//37Ym9nFA23GmNaos1dF2gnmKYsY9NUNZn3wqet+P+l/7bXXhoG/xx9/vHDpH56EsUZbbjYbpA28MeZbcvqdkuqQXucGrs/ZjdzW1aujmhHD029uYhls0xqPg8BgHa+zsM5KGbYnZqHzyiuvFP/KqbIZo3x1tF8Ub9qv0NsE2CDNVtMMGgbT6Bul2GaYhcps9S8YGGMdtc2bN4c+wk9+8pPgJtDdF198MdyH8NBOs9C0zI3eFmrqL6ZuOR0zWjzQZowZOYO8usHTHGZ98MSoX2hY01cyaMiqyDVo3BTvscceM6aEG2NGB/YhZzdym17t6AqefjNDlifO8cMH3QCXkb7yJng9BDtUd70xpn8G6X+0pV9b8NBDD2U/iFLWT9EHE959992wN8YMTj/9izVr1oQ99wUMlNNHYLCNDzLEA3+ce+ONN8K1W7ZsCcvgMIiGjtO3EE39mfHEA23GmNakH0EYFcz44HVRZqR1QfwlMNY8AS2CKlhrDrSosMAfCxn3O6vOGDPVkZ3LMGifDrTzRUFIXxfRMR9IyfHEE09UvjZqjOn1Dj/88OLf+NOvLeAhXvraKGigLV2GQ8t4eDaLMd8yG/0LvvIbz4qjj6AHclWzcTXjre5DBk39mfHAA23GmNYwiws++eSTsB8FDLLxMYW77rpr4FchCIsFUuMPKbDeCfCkKAZ/vJYRP5lmkO03v/lNo1l1eoJV9uTamIUON488qZ2r8LQ5fvjAwBt5Sl9N1ysguRmw2CTWcqn7uAv2iafjxixUdtttt7D/6KOPwn6c6ccW6IMoueUoLrroorBP15dl4I4b+dxr57YZZiGDLo2yf4EepraJexbSUQaDZ+gpXyatGhxs4k+z67U+tJldPNBmjGnNIYccEva5L3F+/fXXYa+ZYMBNJA0d64vwvy0MbPH1Hhow1kJiLQRtdFQ1C43PeLNWQrwWAudZ10ADXjwJPuuss3r33XffjAE7BtJWr17du+mmm0J4pFPhaBAOeNLMF4l4chyngy23GLHK43vf+17YG2NmwmzS3OLDshXYjthuyLY0WX+lCs0qyd2wEzbrQC5fvnw6bl4JwZZgAwB39B47kr6Wescdd4QOsfximxhIwz0Hr43yqljVQwSlQ7NvjVmI0FZz05r7uNK42QxoawuqPojCzTUP/uinKC/sr7zyyvDgL31V1TbDLHRG3b+44oorwmui6DkQNv9JQ/wgDXdsAvaCPYNnZQ/hmvgT+GdgfdAJCaYjJowxpg8mbwonVqxYURxNsXbt2gnMSrxt2rQp69aUycZpYvHixduFoS1OA/Hjd7ITPrF58+bgNtkoTV+P+2QnNYRZhsLAP3mM/W7cuHFG3OnGtSmrV68O8Rpj8qCr6E9sF8rsRuqW07kmpOGwxSiuyQ7rxPr164Mb+o8uyz+2B/tSRuyfcKrsHramKiyQ/amyX8YsBNBJdCFmHG2GaGML6H/U6XjcTyE8ws9hm2EWOrPRv0D/475Cei9BuLjjh3uEMv1s6k9s27Yt+K/rS5jRsYifyUoxxphW8DR50vj3Jg372D05YSYaa6flXr0YNcyA4cm1Fy01phx0dvLGMXxmf5zgCfJXX301FmsxjmsZGTMbjGvbapthzHixUPQA23PbbbeF5SzMeOBXR40xfcErCuvXr+/dfvvthct4oNdIx2GQjUaPaeseZDOmGj5wwnqIudfBZgteweADBXXrpo0CyoXO889+9rPCxZiFzW9/+9veNddcUxyNB7YZxowf49i/GAYMsrEsjhkfPNBmjOkbPbFlQGkcIB2vvvpqo48UDBsG/P74xz+ORVqMGXeYFUsHkXUSuVmdbVifhfUgu/j4yqBQHrfeemv4cpnXXTFmCh6mXXLJJWHtxHHANsOY8WTc+hfDADtIHsdhkoH5Fr86ahYMLJJvjJkfjKLpss0wZmEyyq6x7Ywx48ewbID13Zj5Sc5meEabMcYYY4wxxhhjjDEd4BltxhhjjDHGGGOMMcZ0gGe0GWOMMcYYY4wxxhjTAR5oM8YYY4wxxhhjjDGmAzzQZowxxhhjjDHGGGNMB3igzRhjjDHGGGOMMcaYDvBAmzHGGGOMMcYYY4wxHeCBNmPMnOSdd97prVmzprdkyZLCZe5B+k8//fTiaO5DnVxwwQVzuk7MwuKzzz7rPfzww73jjz++d/PNNxeuc4sPP/ww6Bz6N9+xjTGjwrZhfCAf1MHee+/de/nllwtXY4bLU089FdobbMBcZfny5b177rmnOJofyDaTt3G3zR5oM6YPFi1aNL2h6Ch9CoY59jdqQ00DwSAOcdM5qQNjFad3LnRmtm7d2vviiy+Ko7mDOr2kX8yXm+TPP/98TtbJqIntQ9mNUKqTbKOGdDEgrPi54akCuxGndy7coO644469Z599tjiaO1AXtD3ffPPNtM5xXFdHcx3bmClSXeOGMEfsh60rnUTOuIHDfhEuNz5VIJvyyzYXbl5tG8aLuM+0EJltnY9ZKPr/3HPPFUdzh1jX5+N9BlA3b775ZnE0xkwYY/piw4YNE4sXL55AjVatWlW4zmTz5s3hPPvZYNOmTSF+NtJbxrZt26bzsnLlysJ1/Fm7dm1I81yCeiDNyAz/169fH/7X1dFcYS7WyWyBfi5btiyUF3v0MAW3pUuXBjmZTUij5LaKFStWBH+kOZefcYU0I7tzCcoYu037gvyw5xj3+YxtzLegYyoPtrI2BPsxLJ2Mdb6KOJ2z1SfqB9Jr2zD7qD/LfiEzDjofM9/1n/yxzSXiewr+x33NrVu3Fr7mPuRn3G2zZ7QZ0yfMFrviiit6k41Lb926dWHWR8oBBxwwYz8bTBrXsL/qqqvCPsf9998//QrjQQcdFPZmOFDOk41f+P/AAw/0Hn/88fAft/n0Gqmp54gjjuj98pe/DDaEJ3O5J7y77LJLmJG63377FS6zB7YEW1c2K4Kn7XvttVf4T5pJuxkePGmnDbr88stDWbPneC4+gTf9Qb1fdtllvckbwWBHzjjjjDCbPQX7MUydxDYwc6JsVgszLB599NGQTpjNPtFCwLZh/jIuOh9j/R8vrr322t769et7TzzxRO+NN97o3Xnnnb3jjjuut2nTpuk+mhkNHmgzZkDuuOOO0MjccMMNtVOnZwMa2VWrVpU2gmoAzzzzzMJlJpxnerqmezMYhJtgKjJuOs+rtJqejD+mltPYcxNOZ4D/+MsNTKYobk03ZyCibOozU+Pxx5Z2OjineDkfx026tAZDnFf8p3FxjD/Op1tctkoL7nF5DAsGPpQODdYov2x1r4vInzYR5xXS+iCOKpmPX3NQuiDnBnH5pvU0nznvvPOCjjLYRvmOK5dccknY33rrrWGfct111/UuvfTS4mh7Yv1PZadOttroaQ7iRhclW2Wv0sQymJPPrmxdbCPijWvEOOmDbcz489vf/ra3ePHi3t/93d9Ny+WokG0oe6DHwzz5yVFlG6CrNjzHsG0DkB+uIew0HNIcE5dFuknP4jCGLcdxWkDly1almyB/2oTSLre2eg+6XmFAGq6I5YIt7cfOVWZT52MG1f86ea7Sf3SCY9xBbStbnQwBcce6i5zkZCOWIdISt3lpGMPW/9mU51jHSA950jH/q4ivZcN2QxxG7FZW5znisKvCFZwjXM6l9dUpxcw2Y0wfMGWVKblMzWbaNCqVTmufTTUjLUx5Zqow6Vi2bFlx5lvIA1PM8YufeBou+eIavbaGH14/IExBvnndFL/Ew7Hi4VjTxZm+rPLCP25V08cVN9cp7PTVB4VN+jiPP9IW+2HqNH5UL7pm48aN4Rh3pZm4cGfDT/wareLHD+hVDLYYzsdpJlz8cAwKGz+kjbTzP05Tv5AP5Y+4gf9xfeVQXvCrdArSr3oincShslY9xtcofsE5ronTkHMjDtxUT5QL4RDefIb8Ko8qzzTPlJPKZbZQnVJHaZ0D6ZO+cD6VOWQdWZLsSOaVrzrZwh/n6/Q0B3Ej34pr9erV4TrchcKRm8KO/RA/fkgT6VR6gGPJPunjv8oEt9jWET/pifUKP7Kz0EQfZFvwKz3lWGkaBqRJ+STPwH/bmNlF+SSP5ImyjsuMPNfVUb8QLuFLjtN2THUB+I3rDupsA+fjY9W/4sGd8AmDa8fNNuAWp4c0Ep/yEet9GjZ7XSeayDFxd2kbSDN1x6a05eoyRfHiL5ZHULqA8MlTld6TX9yUb5C/mNSNMIhL5cz1pIn0z2WUfsqQ/JKntLxGkUfiIC7pLTIcQ5qoW8jJDOmvkmfpgM6n+s/1qnP0F//4JUzKpArJp2RD+kdeBGmW/JAXZJRrYj/ERRp0nmPpGm5d6j/h1clzbMcUH9fgxvWDQtrJI2GrnvhP+OS/DKUdf6mckGblqa7OBW6KH7g+vg5ybqSVTfVFmlL96YpqC2mMqQQFl/LKYLPxX6DgswVpk/GVEYyNDUYFY8ke95zR4roYGXDlkfzKOILOC4UbG0i5xWlJIUzSFkNjQ3xCxjc2jnIThBNfg1/Ox/lUQxqDW9xwKdy4EZGb8kGZpGlWwxmXkcqO/KgBjWWmH0gX8bDFkIc0TTly+eN/XP9xekF5i+sxLX9IyxJSN8JV50Ko8ZvPUHaSRWRTnZC4LCinKl0ZBapTdYCUZhGnkfNpfVOPsWxJDyVPTWSLMOv0NAdxx+WJrhF2rJMcY7ticIvzSThd2DqOU7uKW5yPJvpAeVKOyg97juNy7hLCJR62GNJtGzO7xPmUjpI35AEov7R8uoJwCV/ykcZDfUmPOJfWXZ1t6KoNz0G4o7AN0CQc0pvqUlpms2EbSBPh5PSwLsycP/631Xv+l6UhJnWjXur6sXORWLZHrfMxxEFc1ClpSOOkPtgglWWok+cm+q86V94hlYMcxJ3KBnHFskia62zLKPW/iTzHuh6nrSt5V5riepMMxvqZQ3qc1nlcnk3qHFI3hR2nIXWjDNIylr2J67Ar/OqoMR3BmgMvvvhi+MLTKaecMrJpvE3RK1283iWef/758Npa2RoOrB/GmkyaesvGK7Lw/vvvhz1fgDv//POnX9/Q+RS+EJPyyiuvFP+2h7iZNhzD9GviS8mlX+VP2riGY17tOvTQQ4N7Si6M+GtjO+20U9h/+umnYR+z2267hT3+Jxu3GeV10kknhXPxtGStT7GkmN4Og65Z8frrr4f9ZGMS9mLLli3blWOOc845J7yCEL8W+Nhjj4XyE5Q/m6bq87pCVzzyyCNhrZG47HiVEn2Kp+jPZ5DBZ555ZnrdlaFNZR8AXlEgfTfddNO0jql+WHMuB7aBeuQ61e2uu+4azumrUU1lq05PUxT37rvvXrhM6dpk/2eGbIN0POarr74q/nVn69CznEzHa6c00Qf8qzwIc4cddgjHw1qDxTZmboCOTt4whLxdeOGFhevwQe4mbwCDPsav6bA0BXWfo4lt6KoNT5kN25AL54UXXij+9Xo777zzjK8ECspHjNo2ECZpmryhnWHjP/roo7CvC3O29b5JP3auM1s6H9OP/kOdPDfVf8jZgDgtKcS95557FkdTEBeyGJMLV/0fGKX+N5HnWNe5x1C8g95nCOqYukbuxMcffxz2uh8qAxuyYsWKGa8ZU24//OEPi6PmNr8fSHuT+7Su8ECbMR2CEduwYUNQ4ty797NJrhG87bbbKhtAoHNFxzPdZGBpCMnrxRdf3DvqqKOC/3Eg7kBhqPfZZ5/QEPS7GPCpp54a1uJjUVHqlU2Lu8YdTY5z5XX33XcXPr4Ft5x7P7z00ksh7rgjrA7yMcccE47jhoWNehM0zNSpFrsnf2+//faMhhk3OsGUwx577NH71a9+VZzpBm7gc2VX15GfT1APWnfl6KOPHsvBNgbr6QSz7gpwA1X1sRWRq1sGaWDYstUvb731VvGvO1uHzsd2WJ36dJ3MpvqAjtIpHbaeNLEx8Top2oRtzOjgRoX2nhtJbvxGRfpAD9n+0Y9+lL1RjcnViWwDdNGGd80wbMOVV14ZbL/WOsL+M8DNA9GYUdoGDbCzAH8M9YA9gHHX+7p+7HxgtnQ+pl/9r5PncdR/PQiAUet/G3nGjnYp5+q3pOvxMmDIgCB1Fq+Npk3Xwdlnnx36Der7cF/FPVbMMOu8zX3aoHigzZiOwaDpydLVV19duI4HcSPYtAFkMCmFThFGkz0dIwwrX7bputOiDl4MDVpssOvA4NN4Mdvw+uuv77vDSTndd999vS+//DIYf566s4Dmr3/968LHFNxAUy4pLHA6TGiIdLMreGoM6iDTOMcbjV2M5IMBFGY7nnzyyeFYnHXWWSGeDz74IHTqcjN3BuHpp58u/n3LsMttHOEGRLNjzz333Kw8zSboOR0qZrXREUQny2azxeTqUm7Dlq333nuv+Pct6uQ1oUtbx7XcEGGH6YAySLlx48btynDc9KGJjcGmpHYmxjZmdHDTsHLlyjDA8dBDDxWuwwX9iB/oNXmYB1W2oas2vIxxsg3Y/htvvDEMRGEbeNjC10LTQa5RyrEG2GOoW26U9YBl3PW+qh87n5gNnY/pV/+r5HnY+o+upYy7/s+mPDM7XwNqgj4gda4B1sMPP3w7exDPdFMfEvngWmbdxfeiw67zUd6neaDNmCGgJ0s0duNE3AjSQaprAJnKy4Bh2ujcfvvtvX333TfMGmMwoOyLpYPADR1hY3BjmD3T5KZe8JTlkEMOmfH0tB8wyjR6vNrHE2I9/YgbB3VG0wHWYXWABQ0VnV4aN4Ebn/RnhqWgsY63tEOAfKiT9sADD2x3HrlpMjibI23U0mPFm87gevLJJ4t/CwvklbpD/+Inp+MCHSr0E52om82GvvKU9pprrplR78jou+++G/4PIltVYKeIm05bHDdyFr/6VUeXtg6bxusq2BLsCE+cTzzxxOLsFOOmD01tDDYjtTMxtjGj5a677go3geR7VGhQ5Qc/+EFtXTaxDV214SnjaBu4UebVMPpc2Ab6GqkOjVqOcwPsDKzRl1RfbDb1HuL6S+uurh8735gNnY9po/9QJ8/D0n+gz84MwHiACln64x//WBzVM2r9n215pj6OO+644mgKZlBSltJr7EJqD9LBsp///OchH9S/ZEYMWudff/118W/mfxj1fZoH2owZAJ465J7EgJ4szSY8qeUmLu6EMAgI6dpsykf8dIepvDx1YP0EpkVzg8ie9/25lnU/QE/OaCQwkIDRYtPT4niNIhm+qs4sg4B0grmRw4grbqZlC6U1biQVpuJgzQNmxtGIUw5MRwbWFyFM3Cgj/MTlpP/aqzFlFhvpYONVB8LgpgBoFNRpYM0izpH2O+64Y7sb6S7RzD89MSI91Bsd4bRDW8dFF10U8pl2rIH64EkaZUIcqnfqWOWqOok7TTSwNKj4QSYoNyDd1B3hcbNDvAceeOB0fVOGwxjEHScoO3Qmlj1B3TE7drZRXcZ1StqQBzpD8cC3Oiup3eEpLTLAbFDqn43Omgb762QL9yZ6moKd4okwssU6H8gVcWNX9KqC8iXbBWm4Xdo6rmM2oOwIZUm64o7zuOmDbcz4Qt7QDeleDPKvdR+HgeKW7IMGVSB+mEd9So7iuquzDV214SmjtA1NwgFsB4NOsg1spEs2EEYpx9QZA+y8zimIC9q+ZjWo3kvGYllTurhpptypP9IL2FPCquvHzkUop9nS+RilYxD9r5PnOv2HJvcCOfSQkEFBZEeycdpppwV35a/Ktoxa/2dbnklfvK4dceOGzLWBfKD3pDkdhGtS5yrT+J5V/RMe3FAP+P39738f3LjH5ZqR36dNGGNas6n4ikm85eBLKcuSr9WMijR9a5Mv20x2Roqj7f2ykUfA36RRCm6TRnG7r77oazeThj9co6+34I5fhcdGvDm3Mvg6DOfxR/jxV2rkro1wc276wgzHpEl1ghvnYv9subrFTdexpecpF84De+LBjXOTN6LT54YFcaRpUv31A+WYSzPlT77Y+DoPssF/+c+VP+BP5Rb7Jd1xOvkvf9QPsjSficuKrazO0nIaJWmdciyo3yqdZJMMADIjXcRv/AWsOtlKw6U8cm5lkA7Cwx/2TPJdFk7qBl3ZOvJKGEpPvMXlRRzjog+2MeNJmYyloGvIfZekcbMJypmyFzm/cVqrbENXbXgZpG2YtqFNOMqr8htvcXlx/SjkGH1M0yGd6wfy0I/eV8m5+qeSB/xynjAF4VX1Y+cSVWURQ1l0rfMxaTrYBPLZRv+r5LlO/wknDlf1n7qVQVwKn3AJU8RhsJXp8qj1f7bkOZfuuJ7bovJJqavzsvID7AfHlAs2AL9ch7tsD3vCxQ9+yYPOdc0ifiYjMcYYUwFPQl599dXpGYGCp3STBjs8rY1n9owSnsowQzGdYm6MGT94cv6zn/1su6fPPPnmqWrbJ8OjwDbGmOHDLCy+gpr2Jeh/8DV7ZteMEmZ60McZR5tkzHxj3PQ/hdlf995776ynYy7hV0eNMaYGpi6zFtV+++1XuHwLU56XLl1a+0nrYUEneGuydpIxZjyho8rXCnOvePD6WvoKxThgG2PM8OFVJ14Hyz2w43WnZcuWFUejI7c+mzGme8ZR/1N49TVdn81U44E2Y4ypQWs98OlunjjxdInBN60B8N3vfnfWbpD56h8DfbM1m84Y0xxsCeuZMKsN+4EdwZ4wm411hq699trC5/hgG2PM8NFaUqx5iD1ggJsNO8HMMtayGiXEywC71qszxgyPcdP/FNJC32W+r5vcNX511BhjGsDNMAtyMtDGwq2LFy8OT3Zm65VRGj1ufmM2bdrkm2FjxhzsyH333RcWgAeeVPN1NhaOHsVixk2xjTFmtHCD/eCDD4YvIQL6Rz+Dr/KN+mHeokWLin+93tq1a/3auDFDZpz0P0YfPBCrVq1q/TGUhYoH2owxxhhjjDHGGGOM6QC/OmqMMcYYY4wxxhhjTAd4oM0YY4wxxhhjjDHGmA7wQJsxxhhjjDHGGGOMMR3ggTZjjDHGGGOMMcYYYzrAA23GmL7g6zhsC4k1a9aEL/EZY7pBX/NdSJBfPtlvjCnns88+C7qykNpc7MJCs4fG5LD+m/mAB9qMMa254IILejvuuGPvxBNPLFymBt6WL18ePgm/ZMmS3s0331ycmQmNJ+fxpy32y423wuGT0vjPQXwMfLWBRuz000+fjp89eaEhV1ikJU6b0gE/+9nPeqtXrw5pNMYMxsMPPxw+GX/++ecXLlP2AZ2UjqJ7ZfqW6irXyF6wR9dx33vvvUvDQPel300hbOKWnWLjP/nROdC5eMMGkd+nn346+DfGbA/6euGFFwZd2WuvvYJbV7YBaO9xY6vSQ+Joc6Pf1DYQbpw+Ns4dccQRve985zshn8YsVHL6D+gI7Tn6wr7sYb/134wNE8YY04K1a9eGLWbjxo0Tixcvnti0adP0MeZl1apV4Thm9erVYVM4bNu2bSvOTkwsXbo0nMeN/2lcsHXr1omVK1cWR80gLaSJ8LhekNZly5aFc4LzxI0b52OUrjgMY0w7sBUrVqwojr4FXURX0TM2/GBbNm/eXPiYAv3jXGxHYl0lDM4TBrYiFxfIT1NIB+khnXF8pIc0yMYIueXiwS21L8YsdNAT2thUX7qyDRs2bAjX4W/9+vXhfxoX0A9Rn6YJbW0DYeOmtMTgj/iNWWiU6T/6gG5JVzhGf9DnGOu/GSc80GaMaQyNAQ1D2ijRKKaNghrBuKHi+qoBMjU8uobGhkYoJXfTWoUG2dIGWRBW3IADcXBNDtLFeWNMf2Az0kEm9DO1L/zHLdU3dDq9wY7hGnVqZVdS/4N0pMvsD3kgbUJxxx1swbmyTr4xCxX0J+1PdGkb8B9fQxjccMdgm3I6W0Y/tgFy6QfCILw29smY+UBO/3XvkfYZ0Le0DbX+m3HCr44aYxpz66239iYbhd4uu+xSuExN8Z5sBHs77bRT4TLFCSecEPavvPJK2APXP/LII2HaNOsQxFO5y/jiiy+Kf1Mw5fuqq66akYYqeFVr3bp1vckGMLxKloOwfvnLX/Y+/fTTwqUayoBX3speWzHGlMNrFNiM+NVzeOKJJ8I+1m3+S98Er3Kg06ecckp4xQIdb8I333xT/Jt69RybxasaTbn88suDPfrFL35Ran+wMXvuuWdxVI3ifuyxx8LemIWOdFv9BzFs2/DVV18V/6bCePDBB3uXXXZZ4VJP17aBMI477rjenXfeWbgYM/8p0//nn38+7FmyJuZHP/pR0Lv3338/HFv/zbjhgTZjTCMYFKMBO+aYYwqXKeKb1xjdRL7wwgthDzQyK1eu7L3++uu9n/zkJ71DDz20drBq8eLFxb+pG/S2N8cPPfRQ2NMgV0GYTcM94IADwt6LlhrTnttuuy3cIKd8+eWXxb+ZyOao08yA+OrVq4NtwCYdeeSRjdZr3GGHHcIem9O2I03nWzf06QBhSptwDznkkN4tt9xSHBmzsLn//vvDPm2Lh20b9KCQfg436HfddVc4bsKwbMNBBx0UHkwSvjELgTL9jwfCYg4//PCw1wN9678ZNzzQZoxphJ4YpTPXdtttt7CPB9RAjcPOO+8c9kAjw2DZ559/3lu/fn3Y8+RJM9toXJcuXRoaTdzuvffe6Vlo3By/9NJLIQzOaTFR9ro+h9KhBrkrSOcbb7xRHBljmvLmm2/OsAtCix6nT6E/+uijsNdAGXbi+uuvD/rHzDgG7W644YYZA9+rVq2atkk8FUZfGSDHVtx4443THWk64diRqg8mgGa75gYIB4E8k4cqG2bMQuGtt96a8XBNdGkbzj777PCwD52T+7HHHhv2V199dW/t2rVhRgl9lSYLpg/LNuyxxx5h/3/+z/8Je2PmO2X6L12I35CBTz75JOx1X2L9N+OGB9qMMY1QA7fffvuFvaADzCw1nuio0WJwS0+mjj766LBP4WtCv/rVr0JjqGnh8Nvf/jYMsO26667h5vfaa6+dvjnmP5x11lnhRn1iYiLsOR41pI0BA2NMc3SjzNPaFH199OKLL54eIOcVz+eeey50vjWTNAb788wzz4RXw+OZYbIVDKKhp9gVoCN95ZVXho40X/niifG2bdt6P//5z4OtGvWAl14l0YMMYxYy9COY5ZnSpW3g4R0D8fQxsAUbNmwIfrmZJhw27NQZZ5zRe/HFF8PG/3SQb9jsvvvuYf/uu++GvTHznTL9ZyCMh2U33XTTtB7yYOyBBx4I/w877LCwj7H+m3HAA23GmIFhdggNF6+D8vSHtdgYQAM9KcrBNGsawY8//rhwmXotc8uWLWEQjUaSG+L45pgbYRrjk08+Ofhnz3HZDbJmzrz33nthb4wZT9D9jRs3hrVO6FTzWfx//Md/DLZEM1vLYG0U2RzAVmA/sCPYE8KOO9Lw6KOPhnVQ8IudIt7XXnstnEvRjBmehBtjRkuXtgGY9YJtYFY912vGvAb0nn766elZsGz8xy2HbYMxw4U2modlDMLxOigPuun307ZLT8uw/pvZxANtxpiBoRG8++67pxsuZpPwpJm1EnhSVAXXpq+jxqQ3x5r5oac92pfNCNGA3OOPPx72xpjxhcF3DbTz+gdrszBj5dJLLy185GGR5NwrJyLtSAMz3TSjTHaq7OmxOtvc6I/6ybYxZni2IZ0xD7zCxs284D9uOWwbjBk+6Fn88IzlYBhAu+OOOwofeaz/ZjbxQJsxphHpoqNl0GixbhoND0+NqsAv26mnnlq4zCR3c7zvvvuGvdZm0F7uKTytYtYcT7+q1lngXJtGknSTR2NMc7TIcbqmYw50kq958Yp53YA9M1avuOKK4mgmuY40YBe0xpNeR9t///3DPoc69Ly+Rpg5cG+y+LLQIs9a69KYhQzrHNFW19GVbYB4xrw4+OCDw8284D9uZQzDNnz99ddhr7WajJnvNNV/7g1+8IMfhIf5dR8gsP6bWWXCGGMagsmYbNiKo5ls3rx5Yu3atROLFy+eWLVq1cS2bduKM1OsX79+YunSpRMbN24Mx1u3bp1YuXJluC4H13M+DQcmG+NwTv/ZqiCMyZvqkH7SFsfJf9w2bNhQuEz5J634V3pTFJYxph3oK/qYA91D5/CDLdm0aVNx5ltwxw5hQwDbUmaXINV5gb1Cz4lTtitnb2KwE+g+1/Ff/tlznNos0oZ/8pMLG3fCMsZM6ST6ktMV3Lq2DZyP235B2KQDu6H/ufhi2toGwsY/aVZ6Y1QWuXPGzEeq9B/QQdpz/KC7KdZ/M254oM0Y0xgaODq5KWosaEjKGiMaFRog+SWsqgak7OYYaKxIB2GV3cCm4IdGVQNuZWlW4xZvaZ7VQNY1vMaY7VGHNEW6h47yv0yv6ThLN/Gb6yiLso60UFjYpjJ7k4LeY5+wH3E60jTrXLylNoMwuM4YM/UALqcnw7AN6Dt6XAbXop9sVeHENLUN6r/EW2oH6Jvk+lvGzFfK9J9j3Gmnq+4drP9m3FjEz2QFG2NMLbxeNdnQha/0xdOsFxp8XZU131gvwhjTHtY84XWLutc+5jO8/sKXTj/44IMFbU+NibngggvCmkp1S0/Md/iw1O9+97vp1+2NWQhY/6ew/s8PPNBmjGkFg0x8JXShNoKss8AadI888kjt2jDGmDwMMp177rlhUfOFCutH/vjHP17Qg43GpLiNdT/LLFys/9b/+YQ/hmCMaQUfJuDrOlUfFpjP3H777b377rvPg2zGDABf6rrkkkvC0+uFCPaTLyJ7kM2YmTC7kzYW21C2sPh8hocQvsk2CxXrv/V/PuEZbcaYvnjqqafCZ7MX0rRmnjIde+yxHmQzpiPoVL7//vthdtdCYSHaTmPawk32Y489Fr5KvlBerV6I9tCYHNZ/Mx+oHWhbtGhR8c8YY4wxxhhjjDHGGAO5ITW/OmqMMcYYY4wxxhhjTAf41VFjjDHGGGOMMcYYYzrAM9qMMcYYY4wxxhhjjOkAD7QZY4wxxhhjjDHGGNMBHmgzxhhjjDHGGGOMMaYDPNBmjDHGGGOMMcYYY0wHeKDNGGOMMcYYY4wxxpgO8ECbMcYYY4wxxhhjjDEd0NlA280339xbtGjRjO34448vzjbn4YcfLv7NLeZquo2Zz9xzzz29vffeO9ijJUuWBDv12WefFWen+PDDD3unn376DLv18ssvF2fLeeqpp6avSbcLLrig8GWMmc9gT9asWRPsC7qPvcn1B5YvX76dndCGDSqDsHPXsLnfYcx4gT2gnyF957/cU/3Vhs2oA11XX4Y+SpXNMMaMjn50G/3lPkE6XXfPEd/LsOf+w8wNFk1MUvwfGATnuOOO623durW3cePG3oknnlicaYYE75lnnilc5g4I/pYtW4ojY8xsQ8N0yy239M4777xwfO+99wbbtHLlyukbVBrIQw89NNitPffcs/fRRx/11q1bF85t3ry5d8ABB4T/ORic4+aa62Juuumm3osvvlh5rTFmfoAd+PLLL3vHHHNM76uvvgr244svvuitX7++d/755wc/77zzTu+UU06ZtkXi7bffDvuqATP6FtisnXbaqXDpTcfz+eefFy7GmNkGPT/66KN7hxxySO+nP/1p6Fvssssu4Rz9kccffzzYiZhHH320d+65507bihxce+WVV/Z+97vf9Y444ohwn4TN+OCDD6bDN8bMDm11G90944wzeqtWreqdeeaZQaerwP8f//jH3gknnND75JNPeldddVW4l2Hba6+9Cl9mbGGgrUtWrFjBwF1x1Jxt27ZNLFu2LFw/15hUlr7ybIwZHqtXry7+TYGNWbp0adDVyQYquG3YsGFi8+bN4b+YvEEOftDrMriea1MIiziMMfMf7AD2IgYbgP2I7QB+sD8pK1euzNoRsXHjxu3sExBelX0yxoyWTZs2Bb1P7YFYu3Zt8W8mixcvnu6P5OAc4ab9Ga6zDTBm9mmj2/jFHXvRlLSPQL8Am9AmDDN7DH2gjc4lDQ+dToQCAdHNbtxwMMiGm7Z4wC2+hn0sdPzHL8LLfwSYzqvAPb6WsGLoxCrNXKs0ke40bIVD46ZOM/5xizdjzHiCLqOjuZvXGPzEdqQp2IO0Q2yMWVjQb6A/UQV9COxMbgCuDvpLaV/GGDM7oMPoO/2LNqDD6HIV3D9hJ9Kbavonvt8wZjzJ6bYG4wcdINN4RD99BzN6hv4xBF5xYNu6dWvvoYce6r377ru9Bx54ILwKccMNN4Sp1vDGG2/0JjunYZtM1/Tro0yZvOaaa3rPPfdcb1KowiteTLnkfWZe+9pxxx17zz77bHgFg3hWrVoVXuMAplczdVPX8grGSSedNL22gV7nYBomcd54440hTaypQFhA2C+88ELv448/nk43r2xcffXV4fz111/fm2xcw3/CYDPGjC+TDVSj1zpPPvnk4l9zHnnkkd4555xTHBljFiq8UlrF888/H/orbV/9ov/Cq6ltl+YwxgwH7gfQSeA+o+k6Sk8++WTvkksuKY7y8Eoa7LvvvmEvDjrooLBvsp6sMWa05HT77LPPDvcfTz/99PSarqy3qHGQOmj7GZ+47bbber/97W/92vhcYaJjNDssRqO48RPY3Mgu17LF8JQonnrJCC7XxbNNOE6nUOv1jfhaPRnSbBbCYGQ4hhHo+Ek0/tMZKsqjwtYsGWPMeIPu1s0EwSbVPWXO0e91xpj5A30Unjanr4ykNLFFOehveNasMeMD9wzovPQZ3acvEN9vpGAnuI59FbrfSNF9R3wPZYyZfXK6rTEJ9Fk2Ad2V7aizA8D12ugDNLnGzD5Dn9EWw+yzlFdeeaX4tz08qeEpESPAjPyy7brrruHcm2++GfYiXZCcmWgQLxTIgoSTeZ6ezcLsE2bHKWw2wiVOzXqDeBFi+OEPfxj2n376adgbY8Yf7An2oG4myJ133tm77777iqPmMGOXhU+NMQuX+++/v3fddddVLlJM/+L111/va1YaH3U57bTTiiNjzGzCbBTuGZYtWzatz+j+L3/5y/CfhdJzMKOVN3Q8K8WY+UVOt1999dWwZ/xAYxB8BOGKK64Ib/xxTR2MX2zatCm8+cfbd7fffntxxowzIx1o6xeEK926+sInQpsLv6qTvN9++xX/jDFzAV4zZ1D/7rvvLlzy8Ko6X/fq54uhXHvssccWR8aY+QKva8QP5Nhyr2xx073HHns0em20zk8OvWLiLxobM1p4xSu1AfDNN9+EvV7lFPqSYPzQPuaJJ57oa3kKY8zoob1P9Z9+QY6cbms5qnT84PDDDw97lqdqAnaFpbWYgMQyVmb8mRMDbbl1DurWPhC5d5+5IRa8K51SF/bXX39d/DPGjDsMsj322GO9yy67rHDJg96zDko/N7FcyxOsqgF6Y8zchM4wa7HG22677VacnYK+xj/90z81GkBjxmz6yf8m/OY3v+n9/Oc/L46MMaOC9ZVSGwBaO421nHPsvPPOxb9voU/C2tFNbIXeoEkH9hWfBvSMMcOD9j7Vfw2SxZTp9v777x/2ZW/xpW/O1XHeeeeFdd7M+DPWA200IIsXLw4fQ0B4BU+I+KhCFVKAyy+/POwF07jVMOrDBulgHIsYVsF5RpPdwBkz3miQre6mloGyv/iLv+h7psiDDz7op9PGzFNo6xmoj7d4UF2DbE1eBcUvr5r1Y2vor3jWrDGjhxvn1AYAr4fxKhfL1cT3Kfqf6xfQJ2k6o1X6Ht+gEzavnvMxFWPM8KG9T/U/NwZQptuHHnpoGM/gA40xmrjTtl1nhhwP98340+lAG8Zfr3TGs8Lee++9sI8bCgmXplMCT35oPAhH1/MlUNZN22effXpr1qwJG8KlL/tpkIx1S+JGDgVQ48eUb6Z48hVS/KuDyytidHgPPPDAcA4/fCnozDPPDOfFTTfdNP00iT2d3TvuuCMcg0aiOUf4ZVPFjTGjAz0866yzgo1Bt7VhQ9B3weA7A2XYitgfjWWs92VTxbE7PMHyDbAxCw9sAw/0ePgX2w9sTG59pt/85jfhaXQOrsPOyO7E0Cc65JBDPGvWmDGD2S3cRHOvQX+AjS+Rcg+Su+lmRmt6nyEIg5kqup9B3wmf+xDuLxQ2XHvttWFvjBkPynSbAXmWrmE8Q/cf3KMwkQj9Vrue3mvgR2MYGlugX8E9h/V/jjDREZOCMuOLGGx8XSN1L3MDvsShL3DEX+rha6G4yW/8xY44HLYYvsjB10hxJ9zcl7oIQ18HIo70K2C4E6fiz/khHsIgjvQrpsaY0cNXv9BHdDa3SYexCbnzbPEXRPV1IGxRCjqffvXYGDP/wY7kbIe23FfB6EOUfZEU+4Kdwd6kYGPcvzBmPOG+hHsF9F73Gzn9R/exAWWsXLkynE+v5b5JfRr8lNkQY8zsUKfbQJ8BP+gx+/SeIr3XwA7IrrBxX4ItyNkWM54s4mey8kwJjCxPCvX0NHFjjDHGGGOMMcYYY3LMiY8hGGOMMcYYY4wxxhgz7nigrQKtk/LRRx+FvTHGGGOMMcYYY4wxZfjVUWOMMcYYY4wxxhhjOsAz2owxxhhjjDHGGGOM6QAPtBljjDHGGGOMMcYY0wEeaDPGGGOMMcYYY4wxpgM80GaMMcYYY4wxxhhjTAfM6kDbzTff3FuyZEnvs88+K1wGo+vwuuadd97pnX766b1FixaFdK5Zs6Y4MxwoB+KhXMr48MMPe/fcc09v7733rvSX8tRTT4W8HH/88YXLFONeB8YYY4wxxhhjjDHDorOBtpdffjkMIDXZFiIMaB199NG9K6+8srdt27beqlWrejfccEMYfJttvvOd7/S2bt1aHDVjxx137L355pvFkTHGGGOMMcYYY4xZNDFJ8X8gGGh76KGHetdee21vl112CW4Mqq1YsaL3zDPPhGMGm1auXNl74403wvFCgplel19+ea+j4u4U6u7II4/srV27tnfZZZcVrvVoNpvq1xhjjDHGGGOMMWYh09mMtldeeaV39913Tw+y5dhrr716v/jFL/xaoTHGGGOMMcYYY4yZd3Q20NZ0JtSJJ54YBuN4ZZI1yljPSzCz6oILLphe44v/zIpj/TD848Y1uOHn4YcfLq6cWv+sLDxmXuXCi+EYf5xPtzieFKWJePG7fPnysH6Z0Cu1zGYDhVkF15NG+Y23K664Yvq/1lRTHLEb6SLd5Clde42ZhfFacdddd11xZiZabw1/5Csts5Qu64AwCMsYY4wxxhhjjDFmrjBrH0P45ptvwrpgX3zxReEyBa+V4vbYY4+F11BZzwxOOeWU3u23394755xzgttxxx0XBm1EWXjPPfdcGOC5+uqre9///vd7GzduDP5uvPHGwse366cx445XOzdv3txbvHhx2DhmUKoMBoaI84MPPgjpYkDqpJNOmh6cO+KII0IYvJYJ/K96fZRBNq5n8At/GzZsCO68csvxTTfdFNIXQxyp21dffRXWUXv22WcLlykoC8qOgSzSyzpruKVQth999FHIl9Zvo4xyfsUgdcAgG3V81VVXhXxyjjXs0kFCY4wxxhhjjDHGmHFl1gbaGBw66KCDiqMpcNOrp+eff374z3beeeeFgZnrr78+DIbhxrUM6DBjCsrCY+YU8Fors+nYWDfuyy+/DO7AoB5hXXrppeH4gAMOCDPH4vBzMJjGQJXWpWPj/9KlS2cMArbhjjvuCNdrcI896X3kkUfCMZC+lNSNciKvKQx2gV7z1eu8MQx6MTiW+qE8KKsyBqkDBtYYXMQ/UP/Lli0LA4vGGGOMMcYYY4wxc4FZG2gbJQwWpcQzvXbaaaew//TTT8M+Zrfddiv+bc8DDzwQBsXi8PnP7LO6Qboydt555+kZZDHE0wUMDjKjLYaZbzGUDWngFU5tzLKD9HXPptTVAQOJZ5xxxow4GcSkHJlxaIwxxhhjjDHGGDPuLIiBtjpOPfXUMHvqzjvvDK84sj366KNh1hWzuar4/PPPi3/fooG7frjyyivDK6t6ZZKBrddffz3M6usCBq723HPP4qgc8q7XXOONWWnDYtOmTdk46+rAGGOMMcYYY4wxZhzwQNskzLa67777wquM++yzT2/XXXcNa639+te/LnyUw8BV2bplO+ywQ/GvObwCymuUb7/9dpjVxbpovMba9GMTTSDsOphtlstX/KGHrnn66aeLf98yzPiMMcYYY4wxxhhjusQDbZMwoMSA1jPPPBNmqDGLSuuTVfHDH/4w7O+///6wF3yIgFc943XTcGsCr5s+/vjj4RVP0kF6ygbZ4jDLBvtSSJc+TlAGs9lA67mJYQ568brtunXrtns19cknnyz+GWOMMcYYY4wxxow3Qxto01c3t2zZUjqoo5lVGlzBn/zG16T+QINMn3zySdhDLjzi59XLOLw0jvfffz/MTGMWG18RZVuzZk14fbNqfTC9csqC/VqPjT0DRnzUQBCPPmaQDiSlvPLKK2E2mdLBRjruueeeGXlgwIx4GPyirDXY98ILL0ynRXHFM9hIF3klXOVNM8n4yijXMECogS8+ZED8fNyBa/WBBdJC2ab1228d8Mos6TrwwANDXMRJ3GeeeWY4b4wxxhhjjDHGGDP2TAyBFStWTBB0vK1du7Y4O0XqZ9OmTTOOy9wIJ70259Y0PNy2bds2sWzZsrCl5xcvXhzOl8G5VatWTfsnDMIUuThJaxmbN2+eWLp0adiqriNc0ob76tWrgxvH/N+6det28cbXbty4cTp83NevXx+OKUeuBfJFWIqDPMblEIfNRnyD1AGwVx2QHtJpjDHGGGOMMcYYM1dYxE9vgcPsq1dffbV3/vnnFy5TMONr9erVvYsuuqh3xBFHFK7Dhdlpu++++3bxkcZTTjklzA4zxhhjjDHGGGOMMePHgl+jjVcXWZ9tv/32K1y+ha9dLl26tLfbbrsVLsOFVz7POOOM7KAer3PymqoxxhhjjDHGGGOMGU8W/ECb1nq7+OKLw2wyZo4x+MagF+uEffe73w0DbqPg66+/DvvTTz89rL3GjDo20sK6ZaxjZowxxhhjjDHGGGPGE786OgmDa3xsgIE2FuRfvHhx77jjjhvpK6OCAbYHH3xw+uMJzKgjLZdeeunIBvyMMcYYY4wxxhhjTHs80GaMMcYYY4wxxhhjTAcs+FdHjTHGGGOMMcYYY4zpAg+0GWOMMcYYY4wxxhjTAR5oM8YYY4wxxhhjjDGmAzzQZowxxhhjjDHGGGNMB3Q60PbZZ5/1lixZ0rv55psLl+HDF0MvuOCCEO9C5uWXX+4tWrQo7I0xxhhjjDHGGGPM6JkXM9o+//zz3hdffFEczS0efvjh4l87+r3OGGOMMcYYY4wxxgyHTgfadtlllzDoddlllxUuw+eAAw7oHXTQQcXR3OLDDz/sPfDAA8VRcxhk+/jjj4ujKY444ojexMRE2BtjjDHGGGOMMcaY0eM12mYJXrNduXJlcdQcvSprjDHGGGOMMcYYY8aLzgbaGDhiptXxxx8/vUYbbvfcc09v+fLlwe2pp57q7b333mEtsTVr1gQ/rCkmN67lGmBACT+svYbb6aefHvzgl3CaQJxcz3WkgTBhkHSJ+Br2epVTYeNGGLmwgTDffPPN3rPPPjsdB5BG5ZUtTjcz4I4++ujwmuzll18ezpN+3OM4YzgmDPxSFgzSxXmJ64x4+K/0xP6Ig+vjPBhjjDHGGGOMMcaYb+lsoO2rr77q7bjjjmHgSOAGDCi98MIL4fyWLVt669ev791www1h0Oe9994Lbps2bQrXPvbYY+Gab775pvfWW2+FQaXbb7+99+Mf/7i3YcOG8GrqSSedFAZ+qiDsjz76qPfBBx/0tm7dGtwYpGLwaJB0AYNT11xzTe+5557rbdu2rXfcccf1zjjjjDCoRdhsxPnQQw/13n333fB6KLPXCFuDZm+88UZvxYoVYeOVz2eeeSa4n3LKKWFPuIRB/s8999zgttdee4X8w9q1a8N1vKZLWSnOGAb5fvCDH/R++ctfBr+/+93vpgfWKAc21dnbb78dBuuuuuqqEHaaZ+KYq+vgGWOMMcYYY4wxxoyEiY4hyLVr1xZHExObNm3azg3K3FasWFEcTYTzuG3btq1w+Ta8VatWFS7f+hObN2+eWLp0aXE0xcaNG4Of9evXh+NB0rV48eKJrVu3FkcTIX34WblyZThW2MQp5MZeEGYcLhC20girV68O18VwnKYxFz5lwPUxhI2/OA6OU3+5OIwxxhhjjDHGGGNMOXNijTY+siBY7H/x4sWVM9qYjcXsLr1+ycYsONCMsn5h1hozu5YuXTod9q677hrOMUMuhtliKa+88krxLw8z1s4///wQDzPrmAXXD1xPGXz3u98tXKY49dRTw/7xxx8Pe7HTTjsV/76F2X7GGGOMMcYYY4wxphlz8mMIhxxySPGvHL2SmW5333134WMwcmHzqumgMIDIq50XX3xx76ijjgqvcQ6CXpMV8aClMcYYY4wxxhhjjOmOOTnQFi/SXwaz2nL+mn5IoY5cOIOGTXqXLVsW1mJjDTc+ijAoH3/8cfFvJjvvvHPxzxhjjDHGGGOMMcZ0wZwbaGPGF69onn322YXL9jCbDa6++uqwF10MsunVVT6GEA/kkS4+fDAI77//fngt9cwzzyxc+kfpXLdu3Yx06v/JJ58c9sYYY4wxxhhjjDGmGzodaNP6Z3zBUnzyySdhH7/CmPOnASD28cAQsFaZ3FevXh1mfcWzvRSOwj3ggAPCVz4ZZNp77717N998cwjjjjvu6J144onBzyDpuvHGG8Ng3z777NNbs2ZN2Pjy6DnnnBPO88VSiNdj+/rrr8M+jo9ZZa+//noIl0HAHXbYIbjztVJgnTWtk8Z5DRQygBa7g+LUHnhNloE7BhyVfv7H5ac8x+uxKZ/aA/5Yj468GmOMMcYYY4wxxpgMEx2hr15q42uafLWyzo0tvZYN5JcvjMqd//FXSAlT59j0pUz88CVNvuKZXjdouoCvdvJVT9y4ni+dQpOwcQOuIX2Eo+v1lVHciF9fS42/Crphw4bpcMhTGj7HguuVTuIiHJVDLn9leVZa47CNMcYYY4wxxhhjzLcs4qc3pjAT7fLLLw8fGjDGGGOMMcYYY4wxZpyZkx9DMMYYY4wxxhhjjDFm3BjrgTatG8aHBowxxhhjjDHGGGOMGWfGdqCNhfefffbZ8H/p0qXhNVJjjDHGGGOMMcYYY8aVsV6jzRhjjDHGGGOMMcaYuYLXaDPGGGOMMcYYY4wxpgM80GaMMcYYY4wxxhhjTAd4oM0YY4wxxhhjjDHGmA7wQJsxxhhjjDHGGGOMMR2woAfaPvvss94FF1zQW7JkSfjK6emnnx7cjDHbc8899/Teeeed4si0hfJ7+eWXiyNjFi7YEfTBdM+aNWt6H374YXFkzNzCtmEw0P2bb77Z9zJmToLcov9uw/rHfYDxYt4NtCFcxx9/fHFUDf4OOOCA3ueff95bv35977nnnus99thjvYcffrjwYeYqDGgwiEqHoyl08BhsZdCVjevTzgryFftBhsoGT/CLwcN/l/STN65Zvnx5SDMDy22upQzI56mnnhr0pQr8kmcNXu+9996N9YnGFf9xGpt2Foels5Qb6SmrY0E68ZfbyBOcf/75vaeffrrTtBKWyow66qdxpZy5PqZJfnLkwprLNLEJqcxTD2UD0rE//jeV71FAutmaQD1L7tg/9dRTxZl6kNlnn3026EMdlA9lrvJvE1e/aRyWLUlBRmSTSV+djRHkQ/liS2XyZz/7WW/16tWlMtiWftNJmqQ7yHzZ4An+ZPtzkF/lNd3I+1wE3c/lh61M/igntYsx/YRVR9xfYKOcu2pbqmhjG9K+WM42V4Gt07VsTWxfl7aBtPZj2+r6oHvttVfoq5111lmtyqMphNlEr6sok+WmddpFGsaBMv2os/EQ62e69aOrMXUy1gTSS/6UzrSuc9DWXHjhhUH/keMmoJNt00f5Kl05OSyDcmlbDmX0a7ebtIdd9wH6oZ9+AzIT95G5Li0L/MR5jre0D0G9So/YN7GvQ2FinrFq1aoJsrV169bCJc+mTZuCP/YxGzZsmFi7dm1xZOYi1OnGjRtD/TatS+Rl8eLFE+vXrw/Hmzdvnli6dOnEsmXLJrZt2xbc2OOGjBGuZI0N/zGERxrwv2LFisJ1cPrJG2kjrVzHRnq4HllvAv5TPSlj5cqVwT9pmzT0oUyJS+VaBucpK65j4z/XEV4dw9JZ1TfpqMs/6Ve+4w35SfOOP+phUAiX8lXaqGOOJa9NQDbIH1tMm/yIsrDmKk1sAiDn+KEeKCOuwV8Kssy1hMv1/KeMxwHST701SQ/5VT50zLVN7All1CbPxINcq7y5nrjq9GeQNObqrmukK5It0sVxnZ0h37HOUy6SqxjcyYfy3y/9plPxq+4Ih3SjHzGcI0/kgXBzcI5wYjskPSPcuQhlg0zG+eGYPJWhMsJvTD9hVaG6UpjoK/ESD/XVFMlOWb2mtLENpAOZQB65jv/Ew74Jkrm4zJrIEmXQFf3YNvxKr0iz8s2Wpp/wUrswKHH8/JeskJY25GS5aZ12lYbZpkw/mth4rqUMyHO84Y9tEOLyJUzVA1sqY2WoTtBn8kOYdSjeJn4FYZNG0qbyqiMtX465PpWzHPhpGk8d5LUfu039qm7ijevi+lF5DtoH6AfJdtt+A3lDZuKyiMMB/stPvKEfsT+ux62fPmDXzI87ogIKVBVTpzRUeFrxMg5Umpn7UL9N6xJ5STslMsAKAwVNGxoUu0reMAhNO49taJO31LBggJtez7VNO2voX2zoQAYXg18FRjBGjQTXVjUUw9RZ6hTDTxrqGoiy+Elbmn7Cwr1NhyKFMElXWm6EW2f7BPGTP+qXsGLa5AeqwpqrNLEJlEUqG2rQY9TR4Hoh3ZiNhj+GdJBX0lJnqyR3cT6Acmoi0+h0em0ZKp+0fNXJKmOQNKochg3lkMoW+lNnJ9URjaF8cmmmjAZte/pNp8oxLmu1lTn7QVpzecBvTj+Qjbo0jCvIJelPoXzKbLfOUUax7PcTVh2En+oIdU7cTW1VP+0B9dnUNuAvTSNxNZV3/FXZgRxd2oZ+bRvln9a39CpX33XhtUVl0FSvc1TJcpM67SINsw1pL9OPJjae/Obkl2sH7U+0lbEUpZVr2kDYaX+2CYov1aUysDNpPOqzVYVBubSJp4p+7Xbb9hD9SmVpFJCWtv0G8pbKjOxkfF2ZPYvvTdhzXdqekKYm/dSu6abVGBNQFoQQwaKQy4wu59KN66iA2C2uUP7rPJUlJaHCEA4EAQWUwrY1MqZ70jqsgrrNGSTCqDNU+MGI5ODaYRi6NnlLkRHKGfoU5LrfeAT5p3zbQrxV6SQfVTorvcS9bT6wB1yvNPTTuGLk08ZGkO5BbATX5tKFHOLeBBp0ypb6aXJNVX7ahjUX6NcmUBapPSirl7I4RoU6/Ozr8gVlctdET9RRbYrSlHY80eW0AxXTbxrVdsebwNaoDtn438R+5uA6wkjtUVm6Y0gjMhPHTbnm9FLxzEY6c3JdFh6obppCObDNJ6jDnFxTbugA5V1WfillYfWL4qbum9C2PWhrG3JgF5qkT3FRRshQ2X1CTNe2oV/bVobiTaE80MWuaKvXKW1lOVeng6ZhHKjSjzY2PkYyxX4YEHZOxmKIm7S3rQfdk1S1KWVIlppcWyYndfKITnI+3hQfeVad4T6I7e33WuJnS1F+Y1kaNmVl3KTfkAMdoWyroMxi/SiLizT1k4ZBmTdrtPHeLmus8V75VVddFdxuvfXWsE+ZzHdvsqDDf/Yccx1rtcFkZQS3yy67LBzz3vNHH33U++CDD3qTBiG4HX300SHOr776Kmy4P/TQQ73vfe97vUnBCG5m7vDFF18U/2ZCXbJmSB0nn3xy8W98QV55332ysexNNty1663xPjtyffjhhxcu/YN+9cNkR6s0nazhUKazvOd/3333BZuA+89//vPe5ZdfPr2GQRWsw/DSSy81WiemiieffLJ3ySWXFEczOeSQQ3q33HJLcdSexx9/POz33XffsBcHHXRQ2Neth0DdUq51MhBTlp9+wpoLtLUJrEmBfCE/d911V+E6xSOPPNKb7AgUR9+CHDSxL8Pi9ttv71155ZW9XXbZpXCppqxdk4145ZVXwj7HbbfdFsquKaQJvV63bl2wH5Qr5Xvdddf1TjzxxMLX9vSbxuuvvz7EB9gMNiBe6o42HzdsIhvH/ayBovref//9w17st99+YV9Vhqy9AsSN3qHnDzzwQO+ZZ54J7jHSx37XL+o3naQJ3Tn44IMLlymUnhdeeCHsBwF9Ouecc4qjuQ8yRpnl5PrGG2/sXXvttcVRPVVhDcqxxx5b/Cunn/agrW2IIT7WaKJf07TNXrVqVSijG264Ieh23dprXduGfm1bFbk+KLpKPuvy14Qu9LqpLJfV6Shsy7Cp0482Nj7m+eefD3LdtC3vh7r7nKuvvjrUD7RZG+v+++8P+yOOOCLsh8U333xT/JuJ4i2TH3QyHTPQNcgpeWZ8YNu2bWFdspNOOqm1zg1it8vaQ8nYKNcwHKR/U0bd/WN6bzJIP3UYzJuBNhRVBY0C0GjTiCG8g0Bjyc363XffHQwYN/e/+MUvgkLw4QSOVXlHHXVUUBIMom74zdyAAZ3XX389DEbFbNmypbd48eLiaHtoBOlo9TuQNEpYHPeMM87ovfnmm6HhrtONd999N+x32GGHsO8HypMyvPTSSwuX5tDo3XHHHcVRc8gXHWj0VAuq0lmj04ZNqLs5psPb5sYmhwY1y25MSBcd8lTe2tJPp4ryefDBB1sNJJblp5+w5gptbAJ24MADDwzyxTW0DSnD7AD3A53fnXbaqbTDn2OPPfYI+7Sj8sknn4Q94ZWB3dl5552Lo2bQjq5fvz50JKkP2tg6WztIGnPwwI64JePoLoP49AG4ceyXHXfcsfjXHGSIciQ9dOYvvvji3q9//etS2cLfG2+8URz1Rz/phLbl3BR0Df2TbZ8PYC9on1J4YHTRRRe1sh1lYQ0CurR69eraMu+3PejHNgCLXaMH3NxhI5CNOrAf9Oex49w0L1myJPSL+hk0H8Q29GPbclT1QXfbbbew/+Mf/xj2XdCvXjeV5SZ1OizbMmya6EdbGy/o03//+98vjrqlSsZi6COSbgZZ0C/6uNhq8lGlX2+99VblfVZXSB/SATXqBdraIPJLXXG/QP2w8Z8yaPJQP6Zfu13XHpKWQfsA/dBvvyGmyf1j7t6k6z7goMyLgTYK+tFHH51hBDSrTSPl/YKxx1jEX7bAaEBqOHbffffin5lrMOOJzhFPZJAnKS91f9xxxxW+tufOO+8MHau5AAPA5IenXsh1nVFXY9TmRjwF/eMpbdubIhoPrunn6Y4GOf7qr/4q7MWPf/zjsNcTlxx0BrEddZ2aOni6iNyUhbPnnnuG/fvvvx/2o4QOQDrjqo6y/PQT1lyhjU3g4Q5POZkpyo3bT37yk9qnuLOJOvxtHwjRmaHjdtNNN03fANEO0smHww47LOxT5FczLtvw8ccfh9kfxMsNcd3T2X7TWAaDpzyljsEmcuPBjeCo4ak8+WPgg04+T9R1o5DCbAL8zCd4c+Dcc88tjuYH9957b++0004rjqbQQHjbWR65sAYBu0dfQDNtquinPRjENmC/mEWCfWB2+w9+8INSXchB2fIgnRvVfmZ9DGob2tq2HFV9UPW7GMiYTdrI8qB1Os401Y82Nh44xwO+fmdD1tHkPoc2lv4Ssq90IH+//OUvw/8q2aZPzuz+YUN6uO8hPqWHstM4AbMI20CfgnqK+8X8Jw7KQratCf3a7br2cC73AZrcP+buTbruAw7KvBhoozIQpHgw7MgjjwznaAjpKAwCs+M0XTzeeCpm5gc8YaJh50Z61113DZ+Y1lPAsunS+OW1q0EGokYNBgu5ZbANnUkHi5vAE8dY19hyDQph82Sh7VNa9JUnEYPqVzpNvO4Ji/LQ9sYmxxNPPDGWrxNTdz/96U9LBwDLyOWn37DmCv3YBGSdGzdgIGu2SfWUDjvQgWfWZ1uo69/+9rehU0wbSyeOTitPHenY9GMLy9II3JhgQ7j5eu2110IHlkHMqk77MNKoV9Rj6uSefKR5GxRsKp1qbtZ4nW3jxo3TA7+D9nPmCuhjOrN2LqM2OJZL6pLZ3G0HwnNhDQr96yYzaobRHqT6E9sGQXyUE/0Fbm658WoDfSL6Q/0O5vRjG6Af25YyF/qg/cjyoHU6jjTVj35sPOXTtp/dlKYypv52OmCu/nQ/+jWMNpRyRd/RNR6KMiuV8oV+2pWc/redMTWI3Z5v7aGgTJrcP+buTdCxrvuAAzExx2EhwsmCyy4AOXmTFBa+Y5+yqVj8kH1M6l9h5MLXooVlYZnZpazum7JixYrSBUip+yYLTBIGW9cMmjfJ7GQDU7hsD+nGTwrXEne8peFQNtKPNqBn6eK3daRlwX/c0viV57Lwld+yrWk9kofFNYt3Ko392oyyxT7L6kwoL2VbXI6iLD+56+MtF9Zch/Itswkx+JvszBVH5R9DwK2pXPUDdRBvLKosPaja2silwqvSd/nJyUQujaBFddO2l7JsUgcxTdIIxI+/GI5z8VFvVXpOPtK8QdliwRzjXlX25D1d9Fjh5fJWZw+qGCSdlEsq13Uy0CSd5JEymE9Qn2mbpPKo2nLkwhoEwsr1fXPk0hhvuXqHfmxDGYRT5ycHYdfJFX4IP4bjfmxDF7YNXSCcOoinqzamrV6Dyq1qq4LzcZ32k4ZxIM5vblPa29p4QGaayEJbmsoYIMukMSdruFfpV9l1ZW1ojOqefT+of5uWeUouHtKMW6rHpBP3pmXXr91u0h4qjaNCsprWlcqkST0RRpmsx6jumqD6axJu14yu9IdEmfKBKoEtVQQKO1fpqYBIaOKbJuB6VVhOAc3sk9ZlG6hv5CY3EEW9NzWgGLlcAzIog+QNyAMD1FUQfj9y3dRIpqCj/TQ2aVlIZ9NyJ024lw0uch15jTfkgGtIV9M6x29qL1JoWKvSUgfXpfmWvauKO80fG500wuJ/Lj1l+UnDYasLay5TZRNSKIf45oD/KhfBf9z6uTEcBORE9RVvpIV08z9tL8tAJyiTuk4qEH4bW6g0peWNzNfZrpg2aZTNi6EjixvpiaGs6vS8DNKflgXHdfnCTy5O0peTI9LYpqxS+k2ndCWWI5VtTn9y5Z6Duhi1vgybnE3hWHqpDTtMGVG2qSyKpvapCcTX1A5Aml62pu0BflI5awtpLZOvOpAr0lhFl7YB/7m0NrVtTfugKpN+7VRKW70G3MlvvDWRZcjVaT9pGAfSMmDL6UdbG48cDGLjy2hznyNIO+mM60Z1WGW3dV0/UHYqw7aQNuqArY5cPJJj5C+GvkabOunXbjdpD8nbMOSjCuJL7TnHTdKBzDW9fyy7N0lp0wccBnN6oA2Bp/CqBE2GjMqIlV8NJBUVQ3gSEFW2/CIkKBRhxUIkZcOfGQ8wWtRJquxAvcb1LLgGWaKekZuc4aOuqWfkIN5wSw29jDhxxbI3KFV5I540b6QNmVWjSTrJY10jqoalqdEDriHutHyIX7qWSyN5yl2HYawzpDmd5RrSrjgJn7poa2hJA+HEdZtLfwzxpLKQwrVNGp0qSBvpoB5JE3nmOJa1XPpTSAt+ymiSH1EX1lyjziYgb+QZP5S76iEns/gjDPxIHnEbF6i3ND1l8sNxqmN1KP9NoZzScidejkmX6DKN+FNY6BXxqpMWpwN/uKXy0BTCJx71XeJ4hfzEeZU/5Ycy4nyq9wK/OVlsSr/pJC2kSXHjh+PYT4zqKQ43RWHm8jlXkf1oQq6cY9qEVQXlS33QVhJXvBG+yp/jujrDP37qaGsbiJt+jdp72VPJqUjTKF1GjskHG/lMr8sRy/6gtoF4+7VthN+0D8ox1zfJXxNIN3mr0mv5qZJFpSu+Tnmoq9MmaZgr5PRDcsYeyC95I4/8T5GedkkTGcvVYawPpJWNeqqSBSAMwsrlrw7kI02HyKURSCdukqMm8XKNwsI/YbMnr4QTlwvHkuM6qux2WfqBuMtkIobrpSujQumW7kqmVUaQyxtulAVu8Ub6pQ8xlH0cZgrnuJZ4ctePijl7R6RK0hZXlojPa6tyByktlS0BZo8xQ6g5Fysm8cbh1BkUM3zSOmGLlRHDhhsdHblTb7ixL+uUIANxmPGGwsek8smWk9G21OUNuSRfNIgiTjfnkN+qTmAM/pumW+VatsX6FKeRtEi3cltdg5XTWSDdCpf4+jG0Ku+6MhbkhXN1kK6u5EF5JD1pvZJnzsfpT5Hs52iaH1EV1lyjiU2g80X54K/OL3KjRp86QS9jeZ1tlP6YVH5k18hzGzsC0tM2ED5yzXWKN9XjLtNIfajjHNcj9Sx5YMvpWluwa5KdXIeRY9KRy28sc2Vp0Y1BGm5b+k1nXGa5ehPKh7ZUBgX1QX3OJ8hPmb1IoZwpn7J2o01YVVDHaZ1ow2aJVO9yqP7raGsb8E/cXMMeHcilI00j+p3qcVX6Y7q2Df3YtjZ9UND1XbYzdXpNXLiTtzLID9fHsty0TqGpbRl3yvSD/JAvzrFVyRT+Bm2LYprKGHVDPaVlH9cN55v0c0g//pvqooj1TltMLo34qZOvMrCxXB/bQfImd7ZcG1lFld0uK2PgGq6tgrogTW3z2QVt+w1N7x8FMkP4OQibazhPGXWpH/2wiJ/JBBmz4GBx0klDPdYLyc42LLR52223zcrnoecrLPLJ140++OCDRosmGzNfYFFaFsYe1tfRzLewqPrjjz8evjZtzLhj29A9LCTO4vRtP6phzKjh4yCLFy8OH4Aw3eA+wHgwL746akxb+HrPRx995EG2GuioLV26NHye3XTDjTfe2PvVr37lQTaz4OBLUNdcc01xZIYF7dt9993nL6ObOYNtQ7fwQG/r1q0eZDNzgmuvvTZ8sb3fr/+ambgPMD54oM0sOOiAPPbYY8Gwm3r4HDZPmvUJatM/zBDkU9R+am8WIjzYuOSSS8LTazM8br/99tDJ3muvvQoXY8Yb24bu4Cab2SyeyWLmCjx4ps1C/5FfMxjuA4wPfnXUGNMIOm7HHnusDXefMCtwxx137B1xxBGFizELEwbt33///TBj1nSL7bSZy9g2DAYzgl5//fVgAzxr3sw1GGRjIsSpp55q+e0T9wHGCw+0GWOMMcYYY4wxxhjTAX511BhjjDHGGGOMMcaYDvBAmzHGGGOMMcYYY4wxHeCBNmOMMcYYY4wxxhhjOsADbRXcfPPNvb333ru3aNGi3vLly/3VRbOg0JerRvG5bT4UgI6ha+gcX+ecb1CWL7/8cnFkjAHaVXRjFCyENn3NmjUjsdnGdIVtQLfYBpi5hO81usX3GuPFnB1oQ4hQlLINRaJB7fczwTRUb7/9dm/Lli29TZs29b744ovejTfeWJw1cxnkIpaVJUuWzJAT/vOJaZ3HGGOccyCH+CXMcYN88OUu5bFNR5bO54UXXtg7//zze59++ul0WaQbZUP+B2kgKduf/vSn4VP0W7dunQ5zvkFZPv300/OyYZ+voN/qlKFDOT2nrUj1QpvqGl3MnWdD3ucyg9gZyufZZ58NulHVpndhZxZKm/6zn/2st3r16nk5gDBfQGeQR/QF+T7++OOz9YUuIfv4kf3h2hTc5Y99WX9lWJD2+Oa1zU1ebAPSvlm8DdqnB9sAM05I3nPU3VvEfRO2QdvHQYntGf+b6ml8r8FXMpWfdCNs+hltbEuK7zXMrMBXR+cyq1at4qupE2vXri1cJiY2b948sXLlyuC+bNmywrUdaZhmfjBpXCdWrFgR6lbbxo0bi7NTIDPI1bZt28LxZIcsyEPqD3fcxlFWSPvSpUun84FOLF68uFE6da3yL1Jd4/z69euDG2Gn/ptCfbAtFMhrKktm/EBnkHnqio16Q9Y3bNhQ+JgCXZm8qZm2J2wcoxMCPUntDhu2hnNzFdmKfuwM9jOn98OyM3GY8x3VC+2dGT+wD8g0OoBMItfUVwznceM8G/+RYfq2MYSFHVFdc5yzU8MCnSc+2THi5Zi81ZGzAcgu+YnDIG+yCzmb0RSutw0w44D0hi0Fua+6t1A7q36H+ibUd7/t4yBgk2SDpL9N9FQymqZZNiQOg/Igz7g3sS05CG8Q+zHXIK++15h95vxAW5Ux0mBbPx2OsjDN3IbOGo1UGWr8UkOOwSqTh3GUFXVK4wZMN6t1HS+upQFPKdO19Ma4LQut8UO2BhkwMKMhbTeor1TO0YmcPUHX0AtRphvIwVy+ERrEztDBznUCh2VnBrl2LkJeF5JdnSugF2n/QoNjMWkbjI5psE26xZ7jVI+40R1VG0OaiC+GvjfudZTZAJVHWk7Kf7832lxrG2BmG/RSg1PIZBll8opbqtuD3O8OggbFYj3WfVRdWsruNcgb16eyq7j6lWmuW0j64HuN8WDOr9G24447Fv+256CDDgr7jz/+OOwFU1WZqq/pqExzFXKHyy+/PPyPp+7G03W5lmmn8RRZpmoSBtfwHz9MdxW448b1hOOp3aODadXr1q3rnXLKKaHeclOQd99997B/6KGHwl7wqsH+++9fHI0/yN5kg9LbZZddCpde77DDDgv7xx57LOxzqIxOOOGEwuVbynRtzz33DHteyUip0jVNm+e1ETb+47cN6B51ybXppqn0mtKOX8Lnv+qe83rtjY3/0kn8yD1OV+pGGHrFh2sUH1tu2v8RRxwR9lX1YGaf2G7DV199FfbolTjxxBN7BxxwQHH0Lffdd1/v+9//fnHU61122WXFv2/hNYbJG8fwusRcpV87w3Vbt24N5ZfSj52hLONX5whfyP5Ark1vQmzH0o240HvsDX7wSxrY1DfgfFm/QXaQTemKbY/cCDe2ZbJbxJN7VZB6wa7KnpnxAH1XGyB4hXHyRrk4muL6668v/k2Bjp133nnh/zfffBP2zz//fNinOvOjH/0ohPn+++8XLsMB2UKPiS/m6KOPDu7IcRlVNmCnnXYq/s0EWYf33nsv7GNsA2wD5gpXX31178orr5zRbraB/kR67UUXXRT26qeMiieeeCLsYz2mT7R48eLeAw88ULhsT9W9Rlm56P7s9ddfD/uYWD/RD99r+F5jXJjXH0P46KOPwj5utBFsBlquuuoqHiOE9RluuOGGaSHl3W3cYe3ateG/bpJoyH7wgx/0fvnLXwb33/3ud6GBRQlQLDY6PCgyNwMYvFWrVvW+/PLLcD3KSJo++OCD0MEAOiRcZ4YPa42tXr06NAAY+COPPHKGMQYMPPXOeQwhho16u+6667IdwnEEA0wn++CDDy5cptCAwAsvvBD2Oe6///6wT28EqlB4yHJMna6hV7jTGWTjP/rXBnTvjTfe6G3bti1sy5YtC+6bN2/u3X333eGGBF2jPMgb6zMwuPH111+HusU/6SZu/LFxTNopA8LEf0zqRhwM5nPtnXfe2fvud7/b+9WvfhX80KmPO/zikEMO6d1yyy3FkRlnsM/UITfCGzZsyA6sxSBXyFudvXjyySd7l1xySXE09xjEztx2221B59tQZmeom2uuuab33HPPBd087rjjemecccZ0B7eqTW8C9UmcDJBwLbaFNoSNY9oJIH5khfb/5z//eThPH6Cu30BaCDMG25O6YWfeeuutUOa3335778c//nGQx88//7x30kknhXTGqB7arJlnRgvtjG7S7rrrrsK1GtoV1W3ZTfXhhx8e9q+88krYDwtkHdKHkPvtt1/YV8Xf1gagK7rB1mC+sA2wDZgrIAvUi+qma4499tji32h45JFHpvvdMfRxZR9y9HOvIXuCfsf4XsP3GmPNZKXPaZgaSTaYSismhXP69ZVJ4Z4xbZLptel0VvxMNojF0RRpmDApzNtNc1U87AXH8WtDMKmM202l1ysy8bVmNEwaqjCFuKz8Va9sqbyk4CeVldkkpxMCd/JdBudSXRBpuMi0pqunegZNdY04q9JUhtITx5HLO/9xo85j0FHSE0Oe8EvaRS59qZvijafPUx7kNdV70GtwaZmZ8YN6pq7Y+J/KUQrylnsdIkayMZfrfxA7w/lYx2La2hnKMa4TzufCj8NsQ85+yI20CvKb0/U2/YY0famb4o3LQOWV9jmAuFMbZ8YD1RsbMtykH4iMxW0MbV8qIyD3JmEOQk4PINXhHJwvswFpuOQZOcYtJ+e2AbYBcwHkJ5ZJ5IV6KyMnD2Xgr67fMQxIY66tr8sb59HbMuJwKTfJPdfQJ4ihTH2v4XuNcWXezGjTdHC2XXfdtfeTn/wkjCDzCk88DZXRd550yS/bm2++GUah06dBMTwZm1SeMIIcc+qpp4b9448/HvZCr7kIRva5Po6XJ1DAiLYZLTyZ5IkGMpIb7eepwaTRDE8KkJeF8kQQOeUJSBXStQMPPDA8wZ3sKIYnPel07351rSk77LBD2KevhsMee+xR/PuW9BU9Zi3yKkcMTxmRCdLeD/ErPJQHT97Q+xTZh2G/2mMGBztBHU52WP7/9s411q7iTNPL3b9tMKD5QWjEYDMKApqI2CSDAAkkbAKZFggSc2lFjIggBpRRIBiwYRiGi21CaA3iYhiQaCZgCESgFsbgSCBhGoWb2wgQo8FmEEPzZxwD5vfEc5466z0ul2td9t5rn7P3Oe8jrbP2qlWXr7766qtaddYl9I+JiVF5Js8jjzxS/PSnPy2P8vDIF7ZR9YjEbEZ3mejVDlW08TO6qw4/LR/D+A/4mi7QHfHcEZ1y+OGHl78m4ZGOmF7nDW2JdcB/wycm2Vmfijxd6cF0C+02MQcPdyTx6A9z1tzjfwJbYgyL75Tl7hVsf926dVP9ivmkHtlK7/waFdr6AJ46oE9rrjxxcRnuHomxD7APGBe4e7Xtnau9wF2R3PHN12bHhTbXGsShP9O3mQ+sXr06PBGW3g3oaw1fa4wys2ahjUURJi1su3btCpMXOhmT9PR2yq1bt07Fjbe0c+RIb9Xv5UJpeXnLarqlEwczfdx2220HOCcGQ5wntxu/9dZb4cKaSbBvv5+EvkYfY5Cgj1W9TwUG6WtNMFCx+MHChgZT3q3HhLPt7fM8cpHSS59uoulCwowH2Ct+GntjAlf1zxGFNz0WwntNzjvvvPLI5OjFz+R8DO/V7AIuiJGBRzW4oGF79tlnw3je1o8NMm9oQ9MFixldeOyQhWR44oknwj4Fm+OxqXSuiB394Q9/CO3PohSLKlycYvtcnDb5oVGH+cP28jFN5mnf+c53yjMHYh9gHzDK8BgjjxN23e7Ao4pPPvnkUPKeSXTNzLwLmAdU1dHXGr7WGFVm5TvaMN548sJKNwOj2Lx5c/lrH3X/SYzJrWjDwQcfXP6qhglQLIdoW7bpHv4rgLMUXCjz3wf9txFbYqGWxTbujhwH9N/N9B1J+i/ymWeeGfaDgF6404dy6F+5dwPAIH2tDbfffnuYAPPfHP6LxSD42muvtR7Acv8BgtgmBqHqHTpmPLnkkkvCXv/hTPn9738f3s1TB2MAY5Pe6zOujJKfyfmUrvwMMuD7edfqMcccE+6W4b/TXNi0ZZB5Qxty8wozPnAxyEUld7al0La8zLrqnWJcBNJHuKhkYYn3szGu3XfffWWM4YHMkL6LTcd6V9wgUD/eacZFtt5plMM+wD5glOGOLO7MjO+64poQ+J17mX0buAHg8ssvbz3n7RqujVSPGMLkHwaFfzCQF9dm3AiRw9cavtYYVcZ+oY0XDVaR+w84ToHOmg7WvJha5AYsXVSQNj6v3013J8jh8LWZmC4dgekdvl514403lkf7vuaVOi3+W8BEb1zgIp4XB8e2qsmvFhFzYKe5QRPSvsYAw0Cji+DUltv0NRhkgnjppZeGry1xgcGFBhccbf+Lj3zcnaSFAYE86SJIKmNbmbktXP+Ni5F9pY+dmNGGPsCdIlX/JcXem/7DyUXzuC+yiX78DGMpVH0soRc/o3GZF6HHMjAJ/vDDD8ujwXwMabnAx7fwX2n8DBP/NhPsXucN8bjTVmbqih+77LLLypB9kAf2akYf2ur0008vjyYhDH9x5ZVXliH1MNby0n0esZqOjzcx1mJfaV/mmHD19ZQmH5DOv4ivp1Toi7qrBOwD7APGAe64SjcWbnSubl5eBYtspGu72DMMZL/xPFq/c/Yo6q41cnbPojb6oh+lH7HztYavNUaaCYMZayYM64AXEkL88tT4BZF6ASEbaUk3MQjt90JTvaR0onOUIZPwIkSl48WCbPymHKH8yZPzMeSnc5RL2glnU541w2ZishNsYWf5okraOX15KG1G+9CmiodtcJzaGBCHNh21dqQe1BcbA+rAca4OMZynPqntAnnJ/mPoa4SzkV56a9PXqvqL5Ijj5lBa9M+mcuJ06nfxS4eBstFJ3NbEIUzHoHpzjrpiM6QhHuUgN3vixHkhR5qXQFbkNqMLdkPbYydAG9NmOk7BNtr4AWykya7HhX79DHpCDznU35SnqPIzGq8pl77JlvoTxUnHdOQgXc7fibhvE5+NMmIZSE+ZxEvto828AUiPLNSTNORPOsqTvSgszos6VelScc3oID9BG8f2kLYTtkU82jzesL00LvZBGO2djnPDRv2D+oD6mmy2CuqWs1v0QXicp6DuhNNPpD+wD7APGEdoV9onB3altk+R/cgG4434nJ9OKBP7o1zkVj+pQ3ack1X9RXkK8qZ/cA6bVz9jTxgbeiFv+lLsgxQn9QuSo8lfKS31YlM5cTpkIl7qgykbuamP/AVxCNMxkKfS4wNoX9IQj3KQmz1x4ryQI81LICtym5ljbBfaZGx1GwaWDtRAWoyUOBggBi1Ik+YTdyTikoZwDJuOoE6bkymGeMQnHefoVHGHN8MF3atdaP+cbQDOSg6TjfZOHSfIQcdbbCszDc5d9lxVhxTqntYjZ9dpHA2M6Tn2VX0tpz/CQINQXEYO+pDyTzfSpv1Z+YtYR2y0ezpYcawyiEufZU/ZcT2VXv2bOOSfgzipLGa0iP0Ftkt75yYygvNVPkWQnrxmE/34GfmLGPWhdIt9QJWfoUzKJiztd5Itl47+Srq6cZhz9P+cn6Efcz4Nj2WGunmDII18B+dBcWV38pnYmsrid05+dMD5VBYzs9AusgU27DP1G7S3bCG3aRylbTkmvyb/NExi+6aftLG5nA/IzQnSOLHtx+fsA+wDxg3ZZUquH8RtmLNDbbKb6QTbkz1W2XYK9kz81DbjumiL58rYtPpIfI58pBf6ma81JiFOKouZXg7s4caYOQ1OfSYG615hEMrJSTgDy3QOLhr8mgZr0EShaSJizGwmnQyPKvTX3OIhk2Imu236fFfg0/AzbUBmJuDGjCr2Ab1jH2BmC77W6B1fa4wfs/JjCMaY/uGln7ysPX4PyijCOxNy72HkfRXHH3989rPbo8DatWuL3/3udzP6Xg1jZhq+lsh7lUYZ3o/Cu5mOO+64MmQfvKdv0aJFI/nuE+Tm5e3pVyqNGSXsA4aHfYAZdXytMVx8rTEaeKHNGLMfOGUmaHzdp+2LOGcCZFu3bl14IaxeMsqeLxP+8z//87S+cF4vgP/iiy/Cvgpk4+Wx0/GiamNGGV4kfN1111V+RWwU0IuEf/WrX4W+y8uW8Tv4Gb4Sd8IJJ1R+GGMY6OXxTRcm9957b/Dh0ymbMb1iH9A79gFmtuBrjd7xtcb4MY/b2srfxhgzBYMLXzyb6a8aVYF8TCb52s7O8tPZy5cvD186ms6B7+yzz97v60nIwBeJUvha4oIFCyq/xGbMXIQL148//nha+2wvIB8TbCaufPVw4cKF4RP/fIFsOvvyvHnzyl+TrF+/vli1alV5tA9k5cu3vsA244J9QDvsA8xsxNca7fC1xnjihTZjjDHGGGOMMcYYYzrAj44aY4wxxhhjjDHGGNMBXmgzxhhjjDHGGGOMMaYDvNBmjDHGGGOMMcYYY0wHeKHNGGOMMcYYY4wxxpgOmBMLbXwx5JBDDgmf4u4VPuHLl370SV9jjDHGGGOMMcYYY3J0ttDGZ2dZkMptnOOz2KY9062vUW0f240xxhhjjDHGGGPGhXl7Jyh/D8ynn35aLFq0KPxWtu+//37x85//vHj33XeL9evXF6tWrQrhphoWlz7//PNp1dXixYuLHTt2lEejw6jKZYwxxhhjjDHGGJPS6aOjRx99dLFkyZLyaJITTzyxeOaZZ8LvG264IexNNSxMXnXVVeXR9EB5O3fuLI9Gh1GVyxhjjDHGGGOMMSZH5+9oO/TQQ8tf+2ABTrCQlMK703iHGo+ZLl269IA4L730UgjnfO5da7yDjUUZPap60UUXhTCd4w4xHl9VOvaKy6ZwvY9NYdyh9/DDD4e7qvSONsLWrFkT5ADi8ZstfcwxlSvecotp5H3GGWcUX331VViUJB75UzbxqQO6QR421ZEwPbqLHMgXQx7Ez53n90MPPRR+Szbypd7onLToX+mVFpkURtmSRcRp2Me6idsjlj3OJyeXMcYYY4wxxhhjzCgzLR9D0CLVwoULwx1uMSwgffbZZ8Unn3wydfcSi01acGFR5u///u+Lf/iHfwiPo65cuTIsQmnhhngs0JAv57du3Vps2bKluPTSS8P5b775pliwYEHxyiuvhGPgkUzygdWrV089onnqqacWmzZtKlasWBHCvv3225A+vquKMI5ZDGMx6Mgjjyz+6Z/+KSxgpYtnyPXOO+8Uu3btCpvu9tu+fXvx4IMPht8xLEju3r07/OYxW+oj2agTdaUe119/fdAlsrFQdcEFFxQ333xziL927drirrvuCotYgJ7Q1+OPPx7O33jjjeE8C2Fw5513hrKA82zkCzzu++qrrwb98fjmhg0bQlrq+dFHH4Uw9I1Mzz33XEgDlHnrrbcGman3smXLiosvvjjYAXVQe2zbti0s6CE7MsT55OQyxhhjjDHGGGOMGWn2dszy5ctZEQm/d+3atXfjxo17Fy5cGML4HbN9+/a9ixYtKo8m2bRpU4i7YcOGcEzaOB1p4vPsV65cGX6L1atXhzjEFRyvX7++PJqUjbzTtBzv3LmzPNq7d+vWrSEte0E+hJGHUJhQulh2hcVy5MjFQa+prmDFihUH6HXJkiWhboB+9BuQOc0/lR2qZK0KQz5BebEOVSayCo5pp5g075xcxhhjjDHGGGOMMaPK0O5o41G/ww47LNzJxB1N3MXFI50x3MHE3WF6NJDt3HPPDee4U4s7oLhz7IgjjghhoDvXrrzyynD8/PPPh0cM4zy46wo+/vjjsM/BI67c3UVaHtkE3UUXP+paR+4xWd29N3/+/LDnowYp3AXXDzyCmcL779BxXH/uRENv1As9cZccdePusR/84AdlyuGgNuOjGJIHOwDkijnooIPKX/vgDjpjjDHGGGOMMcaYcWRoC20shm3cuDH8ZjEtXiyLWb58eYibbrlHK6tYXz5mmW7pwl7KhRdeGPb33HNP2D/22GPFJZdcEn4PCguCPJ76yCOPTC3kPfXUU+GRz7POOiscd8XWrVuz9deCIQtsxxxzTFj043HO6SAnj78eaowxxhhjjDHGmNnMUN/RxkIXi2DcyRS/6D6Gu9py4XqHGPA+sBS9ow2effbZ8tc+yFN3l1XBQhSLYdzVRnzupuI9bV1x++23h/eycUcfd3ax4Pbaa69l74QbhM2bN5e/9iH98a62m266KZTLe8/a3q03KHH7iVyYMcYYY4wxxhhjzGyh84W2dNFMHx5gsY0PFMTnuZsNbrnllrAXWpA59thjwx1gLBTF6XisVC/sP//880Pe8cIb3HvvvSF9E3oElYXAyy67LPzuCup7zTXXhDu5uKPr5ZdfPuBjEIPChxtYKEQnMS+++GLYs3h48sknd15uFSxU0mZ8DCFuMxYZP/zww/LIGGOMMcYYY4wxZvbR6UIbiyl6D5celwQeA+XOLu5eY0FLC2ks/mihiPePcfcVX7S87777inPOOWfqPWq884t3i3GeL33yFU099sme94HxnjLyJg573v+lO8e0CMVXLlOQgQU/Hm/NPdKpu+niu+qUT3zHnBb+9uzZE/ZAfVm8Qx426oZ8TXfasVCld5WhKxasWKwjv3RBjUVI9PO9731vKn90qUdgDz744OLtt98O6ciHx0iBL70SF/SuNOQiHm33xRdfhDDVC3J61GIae/3my6fYAY+r0l5s3NV3+eWXh/PKJ34fW5yPyMlljDHGGGOMMcYYM7Ls7Qi+Okl28RZ/iZIvT/I1zPQc4Xx9ki9VEs5XP+OveQJfn9R5vlyZnucLl4Rznnjxlyv19UxtsUyCL53GaQRhcVqO03pWhQF1iescb8hVBV8RJQ756ouddWk5Vjl8mZT6CH3ZlXPoWe1AmL7KqjB0R9lpvZEjDWNLdcsm+NqpyiW9ysqlqconlcsYY4wxxhhjjDFmlJnHn8J0Dndm8fgq70WLIZyPLgCP1RpjjDHGGGOMMcaY2cFQP4Ywl+H9bHr0MYbHWY8//vjiyCOPLEOMMcYYY4wxxhhjzGzAd7QNiaVLl4b3vvG+suOOOy58JIB3jfHusw8++OCAO92MMcYYY4wxxhhjzHjjhbYhoUdHn3nmmbDgBsuXLw8fR7jooovCsTHGGGOMMcYYY4yZPXihzRhjjDHGGGOMMcaYDvA72owxxhhjjDHGGGOM6QAvtBljjDHGGGOMMcYY0wFeaDPGGGOMMcYYY4wxpgO80GaMMcYYY4wxxhhjTAfM+YW2999/v1izZk1xyCGHFG+88UYZWhR33313COProcYYY4wxxhhjjDHGNDHnF9rmz58f9l999VXYzzRPP/10+csYY4wxxhhjjDHGjBNzfqHt6KOPLg466KDyaB+rVq0qdu/eXRx66KFlyPBhke3zzz8vj4wxxhhjjDHGGGPMOOF3tI0IPMJ61VVXlUfGGGOMMcYYY4wxZtzodKGNxaKLLrqomDdvXtiWLl0awmJ45xkLSrz/jDhnn332AXF4P9rixYvDefYvvfRSeWaSTz/9dL9y+B3nwbvWKEN5kweb3rfGeWRT/s8++2wIF6TRe9tEnKfqoPSp/BwTT/LFW+7RUOpzxhlnhMdXb7jhhhAPHYiHH344lEM4+/icMcYYY4wxxhhjjBkNOl1ou+CCC8J+165dxc6dO8PC0c9//vMQBixQsQAFn3zySYjz9ttvT6UDFrBY+NqyZUvIh4Wlc889NyxGAfslS5aEham9e/eGPNg4jhe8SE95r7zySnH99dcXCxcuLL755psQ57TTTgtykf7xxx8P6WO+/fbbKfljlOctt9xS/PjHPy42bdoU4q1du7aMsW/RjEdSyX/79u2hbDaOWRRMIS6PqcL69etDPB5dBRb8Hn300VA24dSFxTj0ZIwxxhhjjDHGGGNGh04X2lgsYpGJ95qxeLRixYri3XffLc8WxXPPPRcWrx588MGpOMuWLZtaZGIR7KGHHiqeeeaZcI44559/fjjH4hfcc889xaJFi4orr7wyHBOPhSjy1YLXqaeeGhboCGPBirjvvPNOiMui3sqVK6fSE5fjGMJOOumk8mgS5QnIf84554Rt+fLlxddffx3CQXX89a9/HY5PPPHE4sYbbwxh8VdN28Ci3V133VXcdtttQXZAbvSKntI76YwxxhhjjDHGGGPMzNH5QhsLQXrMkkWimOeff35qsUrwKKUW2rj7DLSoBOTHnVwsWAELTDz2GcM57nJjgS4mLYuFKe5AO/3008uQSXIfQ6gi93EEyQ3K68svvwz7mMMPP7z81Q4W7eC73/1u2Iuf/exnYR+Xa4wxxhhjjDHGGGNmlk4X2rgDi0dDf/WrX4XFLB6DHAZamItp83VQ3RV3xBFHhP0wuPDCC8Oi3/333x8eM2XjUVjufIsXEHtBcosFCxaUv4wxxhhjjDHGGGPMqNDZQhsLSiwwsZjEY5q5d5EB72RLYYEufqwy90hk/BGB9J1qgvegteGjjz4qf3UPC348ysrjpMccc0xx2GGHhTvwnnzyyTJG7/zrv/5r+Wt/erkTzxhjjDHGGGOMMcYMl84W2j7++OPwHrJLLrmkDDmQM888M8RJv5rJe9d4B9opp5wSjnnZfwxf3Tz22GPDb733LX3fGQt9VYt7Qo9u8gjrsEAO3lP38ssvhzvveOxV76TrFe6Cg/vuuy/sxZ49e8L+rLPOCntjjDHGGGOMMcYYM/N0ttA2f/78sH/qqafCnoWwV199Nfx+6aWXwnb55ZeHu8701UwW3HjUVO9MY7GNxSXePUY454nHHW56R9tNN90U8uDxVO6EAxbiuMtNHyBgsWvHjh0hn/juOO62W716dQgnX+KxSU7udFOe27ZtC3ulV57ckcdvod/aa8GRu9ioAxtfDqUuyrsK6hXrjDrzoQbkpY5AHrfeemuoR7+PohpjjDHGGGOMMcaYIbC3Q1avXr2XLBctWrR369atezdt2hSOCRfbt2/fu3z58ql4GzduLM9MsmvXrr0rV64M5xcuXLhfWhHnwbZixYq9O3fuLM/unQrXhiwx69evD3lzjrIoY8mSJUEWyo/zVvr4uC6M9OTFlp6nTM5XQfnEo/w4XiwvOtuwYUN5xhhjjDHGGGOMMcaMCvP4U5jO4A64P/3pT+FrqTHcicZdaNdcc024c88YY4wxxhhjjDHGzC46/eroXIfHR3k/23HHHVeG7IPHPBctWjT1njhjjDHGGGOMMcYYM7vwHW0dwl1rfHmVBbXrrrsufMDhiCOOCO9te/PNN4sjjzyy8YMNxhhjjDHGGGOMMWY88UJbx/DoKB8uePrpp8NHEfjAwbJly/zIqDHGGGOMMcYYY8wsxwttxhhjjDHGGGOMMcZ0gN/RZowxxhhjjDHGGGNMB3ihzRhjjDHGGGOMMcaYDvBCmzHGGGOMMcYYY4wxHeCFNmOMMcYYY4wxxhhjOmBkF9r+/Oc/F4ccckhx9913lyEH8umnn4YvfC5evLg2Xgz58kXQpUuXHpCGY8okjjHGGGOMMcYYY4wxvTD2d7T9zd/8TbFz587yqB0LFiwo3n333fLIGGOMMcYYY4wxxpjBGdmFtkMPPbTYvXt3sWrVqjLkQI4++uiwaNYL5HvOOeeUR/tDWZRJHGOMMcYYY4wxxhhjesHvaDPGGGOMMcYYY4wxpgM6X2h76aWXwjvT5s2bd8B24403Tv3W+9HeeOONA8L0HrWzzz77gPeo8V62iy66KMTnfWp33HFHeWZ/9L414vE+tvfff788k4fza9asCWkEsl111VVBDmTiN/lRvzQ/joknucgrhmPOsRGPd8sJ6pRLY4wxxhhjjDHGGGPGh04X2lhkO/fcc8Pi1969e4uNGzeG8BUrVoTjdevWFdu3bw9h4tRTTz0g7JtvvgmPhL7yyitlyCQsdi1btiwsSu3atSu8Zy334QIWxD777LPik08+mXp/2xlnnFH7kYNvv/02xP3qq6/KkEm2bNkS0t1yyy3Fj3/842LTpk0h3tq1a8sYk4tsF1xwQXHzzTeHenLurrvumlokZFHtvffeCzKz8cgrdRSUnZZrjDHGGGOMMcYYY8aLThfa7rvvvmLRokXhjjNgv3z58uKZZ54Jx3DiiSeWv/aRhrEQlXuPGotd8OCDD4b3qBHvtttuC2GCRS8Wx9I4LGQ999xzZawDYcHvpJNOKo8mIYy714D8kImNOn399dchHFhYY3GR+HDllVcWS5YsCQuLwKIaciAPG3kdeeSR4RxQfxbo7rzzzjLEGGOMMcYYY4wxxowbnS60HXzwwdkvgLL41gU8TsodbTHpxxC4Cw4Z9JgmG3fZQfq4Z1tyH0eI77ZjIfHiiy/er0zutmNxj8dCTznllCA7d9pxDFqMNMYYY4wxxhhjjDGzg04X2m666aZi4cKFU49MsrD19ttvF1dccUU4HhQWro466qjyqBruOOMOsXTjTrJhsXXr1myZ3MnGnW4svAGLjiy41T3GaowxxhhjjDHGGGPGj04X2ngEkscot23bFu7q4r1ofABh1apVZYzBIe8muNsst5DFO+SGxebNm8tf+4jLY8GNhT7eR/fOO++EDyIYY4wxxhhjjDHGmNlDpwttfKXz+eefD49JcjfX7t27KxfZ4o8BtL27i7vB9HGCKribDfQ+NzHMRTY+9vDQQw8d8Gjqiy++GPZ8DEEysxj5D//wD+EON/RljDHGGGOMMcYYY2YHnS60vfnmm+FuMu7W0sZjpPFCE7BgxsIUi18syj322GMh/NVXX51afNKiVXwHGx9b4PFR8tW7znQnGV8ZJQ0LWVr44kMGlM+jmqTVBxZyeYOOdR6Zd+zYER5/jeXXb+15ZBa5vve974WyKJOyL7nkknCeRcWrr756Smb0xCO2xx57bDimPO4AXLNmTTg2xhhjjDHGGGOMMeNHpwtt3E3GIhqLUyy4sd1www3FL37xi+LSSy8tYxXF448/HvZ8pOCDDz4Id72x8PT973+/OPzww8NiG4tWwIcG9JglC2WbNm0Ki1qUQzhf7+Q3726bP39+iPfAAw8Uq1evDnfUUT48+eSTYZ/mzQIXkJe+jsp54h122GHhwwqUx2/C9KEDUBiLe7yjjS+NssD3yCOPhIU9fYX0oIMOCvkgJ+mfffbZ4rXXXtvvIwvUn3jGGGOMMcYYY4wxZjyZt5dnPDuCu9OOOOKIqQUmwR1bF1xwQViAM8YYY4wxxhhjjDFmNtLZQht3dp122mnh3Ww5LrroorAQZ4wxxhhjjDHGGGPMbKSzR0f37NkT9iyo8e413kfGxgIc7y3jPWbGGGOMMcYYY4wxxsxWOn10lAW2J554YupdZ7yTbNmyZcWvf/3r4uijjw5hxhhjjDHGGGOMMcbMRjpdaDPGGGOMMcYYY4wxZq7S6VdHjTHGGGOMMcYYY4yZq3ihzRhjjDHGGGOMMcaYDvBCmzHGGGOMMcYYY4wxHeCFNmOMMcYYY4wxxhhjOsALbcaYVjz88MPF+++/Xx6ZXkF/b7zxRnlkjOkF+592rFmzpvj000/LI2PGC/o4fd30B33/7rvvLv785z+XIcaMD9gt/d9jWP94DjBajO1CGxes8+bNO2CLYbCpO29mL9jHVVddFWygH55++uni7LPPDjbDPoY8DznkkHCOfa4MJotKrzy6uEhkELroooumyu5nQlpXtxyUSbwLL7ywOPHEE8vQapBp8eLFIX/2L730UnmmGsqQrtKNPJqgTl2AHAxSal/K7iXvnF/S4tqVV15ZbN68uTNZgbyka9qozeBK/VIZtaWyxbrgN/qJoTzZIxsyzJbFxF5sEh+gdmBfZfPoCz2is3ElHVexj9Qu6sDGuvI/yqsXm6Nt1FZsjBNt5KfturTttjZTh/xNLNe1115brF69urNFSfJZunTplJxtdYBO24xVbXxYP2PKuEB9sUHVL9Yvuo/9a5WttpmT9Eo/Y4vop18C6V555ZUwVrYBXaje2trUvV99IV+X9Cs/oN84Hcdw9NFHB1956aWXtvJrvdK2X6e0sWVsrCkOx4PM0WaSVHbarMpPYwfSAxtpYl200VW/pHn30pfxzRovkLmtPQO6uPrqq0P/x47rGERGIC4660U+yuzVp1WBHUj2dGuy56bxsOs5QD9Qdq/zhrZ9m7za2hjpe7WNztk7xmzfvn3vkiVL9lKN5cuXl6H7s3HjxnB+w4YNe3ft2lWGmtnM1q1b927atCm0+/r168vQdmAj2NSiRYuC7ezcubM8M8mE8wrnFc6euIQLwhYuXBhsTiAHYWl+vYBslLVy5crwG/snz7Z1bKpbFfQtdNoG8kUXxOc3ZdEOTWWhK8qhLvGGvLEec1BOWx00sWLFiik5qAf6lf9oQ1qHXDriYJ+DQt7Ip7bBLjhu8nOy11hO1TUGXcjWZTvILmJ7JA/26IoN2xx32tokupOedIwOsMsYztPu6CzW4zhBHVKdtLXlrv0P5VI+um7rn0gT9xlkkp03gX23LaeJtjZTh/pfrv4611bHVdCPyV/2jnxt9B37Bn5XjVVtfBhloh/i8Ft1HrRuo4D0mbMt6ocupHt0SN2xm1g/qS2xJx7h/dKmXarop18CcXv1i9SRTb6IrUnGQfRFvC7pR35Ax/itOF065qLPNn6tF5ANHTT165Q2tsyefOkTyM5v9Y2YQedoMwnyIif1Q35kz9kU+qobZ9vqqh/iNqZc5c2W2lhKOr5y3FYulSt7qGMQGQH5JBvp20I5qtugIH/a92XPdbQdD6WjNHw6oA2QSX1S41yT7tr0bfKmHWg/NuIThzJSOE9ebcoeJmO90AZy4Gy5DoqSx8EBm+6hc9H+bcF+sCM6cZWz53yaJ8fxBBF7o+yUQTu7BpNYNpXV5Ezb1C0HzquXyVrq7DSYNdW7qp2Qua5uON1cm/QD5aS+QgMGA1YT1L2Nr0EXyNxLO6QgK3IxGMWojaugPXITEeSO02lgJL6QLtTG7NO8ZI91MowLbWxS7RDrCegzVW2Mr4j9xThBu+bsp4lh+R/6Evpv61c1kYtRHnWoP7Qtp45+bCYHuqQ+VXKl41I/4PdS/VNmkz9ENuSK65KOVW19mPyNaDumjDq0D3Wtqgc6SHWvuse+iTxSXzVI27dtlzrUp3ppI2wq7RN1ICe22Cv96ks23RX9yg/I2sZPEC+t6yC06dc52tgyx2mdSBO3C2Wkc6xe5mgzCbKn/YE+lrMp9FU3zrbRVb8MMq+jDVK/oTo2+QLyTtNW0dXck/ht+0eXcwDaL9e+1KFJ/l7GwzZ+bRj0M29o27fT+tMP6toRvXTVbv0y9gttIENLG5ZGqhrIOIcBko6BN+3gNCbhyreXzmtGg7rOlwN7aHJK2AJbPMilA4TsMXYIOBHsqW4y0gTpU/nkiJrq2aZuOXBwvegwBR2QRzopaAN6TPt0jHRK/bXFsuK0KZvwQeqB3iinCcogHj4nHQxSiJcOKr2gSUU6eFA24b2CntG3qMonZ4MppKvyu+NOapNV7YCt5cKh374409DfqBN2js/rZeLSb52b+i0yVOk5B34aG44nufTVOj8jfx5vKg+/pjwJT/tRjn5sJgWZyacujcaGuK69UDW2VMkfk/MTaX79+rBBxpRRgTr3o0MgXRyOzbHVzUl6od92iWlTvxjatG3egjpKF8jc1h760RfnKCveBH5RumHjd5s+16/80hV1QK66OSX5Ykdd0aZf52hryyn0c+rQBHl0Wc/pAhtI50r9jrNtddUvyJTKGlNlB/IFdfahOretaxVNMqY0ySW6ngNU0U/auvFQbdLGH3VFlR1gm7He2tLUt2U7VXWU/Q1qW4PQ28g2wtCoKFODJUaXDqaCBsEwpXgZgAyD8zSsBjDO1w0GZjSJ27QJTV6wH+yG39hAml6dljjYCbbBYJiCvah87IjjKkfQBpUr+44hvM4+29YtRYNLPw6KOpO/9NQP6BXZm0DGtC6qa9yHiZdrqybQbVM61Vftzsbvqskz5/BB/aJy0vyRgfBe2gzZU1nIA/2lqNw6ON+m3caR1Car9K3+mtoloEO2cYM6xT6ELeePUobpf6Tnujgx9BfKZiN/0tEWVf1UVJVDfbAJ0rPxm3h19t+PzcTQX+WPqvISnGvyXVUo73Ti3ySnzudsg3DZvnxJWx/WxZgyKuBv2dARtii9xPWKdRUjvQnpW3qpmpO0pdd2ySGZ2sQFZM/VtQ7k4aJa+kOfbeyiX32p/jHYJOWTh47Jl7AmWfqVH9+CvMQnHemr/I3qWueP2qK8mvp1jqrzqS0LfA7n2owvQNxBbH66oZ2RF7nTfoae47GySueiV131C3LU2ZHsA7tOIRwZq0B24gxKk4wpVfLmUP3Yx9BOtGUvc4AcuXl4HW3HQ2SZzr4hP9nrvKGKqr6NrtEx9W9jl2m7TSeDW/YIQYOogfldZXwMbmnDaHAEGiQ1+F47jZl5eunU2ATxaefUYWoSJbAPTY6qHFicvs2kq4k6J0V43SDWS91i5DD7kZ102hhEKbMXiI/e2qSjjFgvDECEpY5eeuilPpSPLyDPtpBGEwfKzCH996oXIV+XojbrZVAhTTpJI4+cTVWVKygXXzobydkkfQp9pP1S4bn+hQ7r+us4QH+QLdT5EBim/5Ff7MXekR0bJR37Nn0wV47aOE7Pb/yF5hI5+rGZGPSuMpv6O7L02x+r8pYuUvlF3XnCZfuyn5SqcgnT1s+YMipgz9SB+su2qSs2Q3upXrKjtJ45+1J68q2ak7Sl13bJIRtoExeIWzVWtoE+k+qvjn70pfrHkDbtX2rfXurTq/yCepCG8nJ+UnOhdHzvB7VpU7/O0YstS89snG+yIfIkXi9ztJlEemSj7nX+vmmc7VVX/UK+TeOIbC21A4XX9QfSpHbQK21kTEGunD3nULvFOu53DpADOXrpp5SrrW48RJZ+5wD9IJtMbVH6a6tvqOvb6hds/K7q/7l2m27G9qujOZ588sliolGKc889tzj//PMrv5D4zDPPFBdffHH4YoW2d999t/jqq6/CV0WOPfbYEC/+UgVfNzGzly1bthQTjjG086GHHhq222+/PYT95je/KWNN8sUXXxQTE6xionMXDz30UOXXfnbv3l1MOJXw+4wzzpixr570UreYV199NezbfGk0ZcK3FBOOLejorrvuKu69997yTDv++Mc/FsuWLQuy9spzzz0X9t/97nfDXvzsZz8Le75q1pbHHnusuOOOOxq/gBSDzHfeeWf46g++Bp+SctRRR4X9xx9/HPYzySOPPFL89Kc/LY8G4/777y8effTR8mh2kbPJs846K4w569atm+rffG3p8ccfD79/+MMfhv1sg/7w8ssvFxMTuFofAjPhf+r49ttvQ5vRPxn3GedzfbQJ2ph8Ynvg98QFRZhLVPn7QWyGL3LdfPPN+5VZB1/too6zgUHHlFHhT3/6U9jHc9RTTz21uPHGG4uJi4XgZ+D6668PdnTLLbeE+QUbX1AjDn4opu2cZBRRHzjppJPCvh/4SuHvfve7/fRXR1f6Ii1fv4uhTfGLjP1t6VV+gd3Iv+a+/ql5y3vvvRf2M0Uvtrxq1api4gI7zJ2ZQ//d3/1drX/uZ442k9Bm+LKNGzeGLyb+4he/qPyKctM426uu+qXNvA5ZGfuYX8sWkYX2Aa6BqiDNySefXB71x0zMPfudA+TodR7edjwc5zlAXd+mX+A/8OPYDzofVWbVQhsGfsUVV4Tfxx13XNhXgYFiqOlGg5LPW2+9VZx55pnBcTERn8nP5Jrhg1NMHT12QBidWTA5eOGFF8JCCh2dAY7JFp+kFkwisJmbbropDISvvfZacMannXZaox2ln/Rm68VZ52hbt7a0lZEJBTqi7uioF9DxeeedVx71BxfUMQsWLCh/tYO2OvLII/teZOcT2/Dll1+G/Sgie+xiMYO+gc13vTAyKuRskn70hz/8IfQl+jeTGgb9HTt2BLufrboQt912W6MP6dr/DAL2/vOf/7x44IEHgg/ftGlTkIGLvX4utLm4STnooIPKX3n6tRn5WPzqXGWQMWVU+Oabb8I+naOecsopYf/555+HPYsvzC/wq4cddliYY3zwwQfhXOyH2sxJcqRjOHOWUaMXGc8555ywICH9VdGvvqrI+QD6eK+0lT+FaxYuNoexwNIVbW1ZoD/mzg8++GAYP6oWHwedo80kyMwiKTzxxBNhX0XdONtWV/3Sy7yOcRVbZPGQRcR77rlnSm7+wdQr9PfUB+ToRcau6WcOkNLvPHw2jIdVtOnb+D7sHptjMVF6HDVm1UJbL2zevLn8tY/4vwpyXp988klx8MEHh9X4UR7IzGAwweFiJwf/LRT851N3RgE2smHDhvDfS12o6Y4qOU32coa///3vQ1gVTLaZkMTb4YcfHhwqcuguD6GLLxaFq2hbt7ZUyVgFi98Mum1Bj0xABp08/eu//mv5a3/aDII4bNIPIoMm2/Pnzw/7LuFuCEgXOGUfbS/GsUf+25yi/0ymEMZ/0FLwndwJPBMTnemgzibVv/lHDYsl9A8ml/fdd18ZY/bC4nWTD+na/wzC2rVr97srkYtb/hFCe/HPtV7hwqZqga6u3/djM/xnl/9cxxcdN9xwQzjHgl3XCyXq52+++WbYCx1rYSil7Vg1iA/rdUwZJY4//viwT/Uq4vGJ+QUXctgJF5PcmUR/iv1QmzlJjnQMv+yyy0J4V2NLF1TJWAX9uml871dfVVQtgPTj29rIn4M0XKcMk0HmoNDGllN0LqeTLuZoMw0LBfjZJl/WZpyt01W/9Dqvw35Z+KCNaWvuXGfexN3jubuSmqC/pz4gZabnnv3OAWJ+XzEPb8sojYf9zhtieu3bl1xySdgP41qrC+bkQhsXkaz+pqufL774YtgzcGjwwHEwKNCZtIBiZh8/+clPwj69hRsHGnd27GDPnj3l0ST6z7T+U82eeDHYEXcupOEpTGaYkMSbBijkePvtt/dz6nJeF154YdjnaFu3FE2c0gl3nYw50Ef6eEAd9LO2DjaHHH160ap2a/rPmpw8F+GDQD7IkpsAyFbqFijrUB3iwYz2xD74705b8IM5fei/zHHb63d6sYNdfec735mxic500NYmaXPugmZiOaj9jAMfffRReOStjq79zyB8/fXXB/hg2W3q15vQgoQejRH07V7uZmxrM1xkcCd+vKmvs1CQuwhBx8jSD8hP2vTCmmPC6xZc2oxVg/iwXseUUeIHP/hBuGh+9tlny5BJmsYnFojQTfpIYps5SY50DFdf7GpsaYvsKLUzqJIxBzKy1c2FoF995eBagjspUh+FHG3Gi5i28ufYtm1bcc0115RH+yA/6AHtTzQAAEkWSURBVGeRI0ebft2GKltOUTnpHdFdzdFGAep4+umnl0d52oyzVbrql0HndcjDP38YK7h7tA7mybl/xmFvqQ+Imem5Z1dzgKp5eFvqxkPaod85QD8MMm+Afvo2/py8u/JznbN3FsGL85YsmXzJce7FkUIvK2WbmDiEl/NNNNLUy/LYk098TFwdm9FnZ8WLOYGX5E9MdPc7J9shXC+VxYY45pyYmFiFMNkC5RAW5yX7wraUlpdmxun6gbzIg3yBvDjGfoXi9FO3FNl9+lGBKtAF5SIPv4FyKDsuJydjTNz32hDnJVnREbLLDyAP+U5czIbjKihXdYg38lNeOfllA9Iv+RBWpV/i4nMGAbnUppSDjGmbEqfKd6GruA4pnFPbSX9pfHRCPWNdsRHWSxuOOk02ybnU5nKgS/JK22kcQGb6T9y30/5EndK+Ede5a/9T9WEBUPr4HOXGbUT5nG+SRT6duMQj77hesg32HLfxmcSts5mc/CmcI47KT+EcZfSLZEDPIP3F5eXkRDfoQWUTh+O0LhwTXuXD2o4p44bsVvqRf031QzhxGSs4Lx3E4GvRmdqEOBqP+qWpXYA4qS2Iun6ZQ2NNW7ABdKJ+pjrLv4icjP3qK7Z9yiEde/KK24Z4hOk4R7/yqzzS0xZs+GD1zxTSkb7qfK9QHuXX9WvFSfVJHetsmTzQQawT4qWyU6Z8QrwhE3oZVagXclMftR0yS5cC3TWNs2111S+USf6pjgmTLcq2CI/BRgmTnVDPJohPXm3iikFkBHTGuaZ+L6iX8kJO8maP3qlrXCbHapsmZBc5UvmRWbYf2wcyVOmO9KmNDRvJLXtERo6lI0jrBoQ19W3al2P5StLgU1LfKZAhLWe6mTULbSgRZaZbFTQOxkmceMADNbby4HxXDswMn5wt0KaCtla7xuE4Kjqw0tCh5cwEcRj0cKTE0aCYOrnYvtj4HZfVLzgT2Sbyy/kI5CAc2WPa1C0HebV1UJQR9xvqTNpUN1UyAjJxrhfkSCk7Louy1U45XaXILqo25Z2THxnisnL1jiFuW73WEdcx16bUmfM528Me6vwa8stmyCO1c46lm3Sj7WcLdTaJXqkv59FVXZ9S3Hjrwgami7i9ad+c7eT6BsS2xNaF/4l9jbYY9I3dpv2eY/JVmraySH70INJ6tfHzbW2mSv4YdENeuTJ1YdAkTxP4RekrV78qOZvGKlHnw9BvmzFlHIn1mtOP6s2+yU9jk9Ih+9RX90NduwDycj61h6Z+mUNjeFuwLekOGar6UU7GfvXFeeyP+HF7xHbO1saf9Cs/MqRlpfqPUfpBbSGmqV9TFuHIJhSffZUtE46s0kmubm3naKNI3OZsVbrAFhWnapxto6t+ictPN+QRlEfZcfsTpx95sH3Stk0ziIygcTPe2pTd1RwghrRVfSKVP+3/lFU3HmJzxOtFnq7odd7Qtm/HbU/+Vb4TYl1pmwnm8WeicGPmHLzUf6Ijzthtx+MAj03/9re/Ld55550yxAwKt0bzzkfe/8gjxcaYPPY//cOX355//vnwLjhjRh1ercHrHubCI/fTBY/e8TXX9JE7Y0YNHideuHBh42Ompj2eA4wGc/ZjCGZuw3Prn332mRfZGmCitmjRogPer2T6hxey8yl/L7IZU4/9T38wvj366KPhxdTGjAN8iffWW28tj8yg8A+9nTt3epHNjAX6cII/OtgNngOMDl5oM3MOJiC83BzHbprhk938pxm9mcHgDh0+NOD/2hvTDvuf3rn33nvDJHtkXw5sTAL/9LzuuuvCnS1mMLjI5m4W38lixgX+8cyYRf/Hfs1geA4wOvjRUWNMK5i48WUcO+7+4K4cPtPe9NUdY8yB2P+0w3oy4wwL6h9//HG4m9X0DncE8UVPfIDvmjfjBots3AjBV2xtv/3hOcBo4YU2Y4wxxhhjjDHGGGM6wI+OGmOMMcYYY4wxxhjTAV5oM8YYY4wxxhhjjDGmA7zQZowxxhhjjDHGGGNMB3ihzRhjjDHGGGOMMcaYDvBCmzEmiz4Rz1eshg1f5Fy6dGkxb968YvHixcXTTz9dnpk9oMs33nijPDLGAF8ZpG9MB3fffXfwL/gZ/A1lzzbWrFkzLT7bmK6wD+gW+wAzTvhao1t8rTFajO1C29lnnx06CtshhxySHSwZUBVHm5nb4GQ1yWK76qqrgpNPkeMnbhtwauQ3Ss6NOvCJfOSij/QykaU/XX311cWVV15ZfPnll1P6Sjf0gw4HGSBpk1/+8pfFyy+/XOzcuXMqz9kGuty8efOsHNhnM+rb8Zbr57Qr41IbH6C45MV+nBnEz6CHV155JfSNnJ61deFnuPjctm1bsWPHjmLr1q3FV199Vaxdu7Y8O3u49tpri9WrV8/KBYTZAn0Ge6S/YN/4gLS9iJP2A23pvIS5rvJiz/F0guzxxWsv86DYB+Tm7NrIn/PopV/sA8woEF+/stXNATQu1vUpzjEGywfMBLE/43fbfhpfaxx99NFTOkk38qaOvfiWFF9rmBlh7xgzMVDuXbJkyV6qwX7Xrl3lmX0QtmjRor0bNmwoQ8xcZdOmTXsXLlwY7AawjRUrVgTbiSGcuJxr00VkY8RV3jONZFq5cmX4vX379lD39evXlzGqUVr2MeRFHZUH5+lXhJF3Gr8ty5cvD9tcgbpiX2Y8oL2weW25sYT25FyTD6CP4G/oXxs3btw7Mdkrz4wn8hX9+Bn0lOv3w/IzcZ6zHbXLuNvXbGX16tXBpukD2CR2TXvFcD71PWz4j9gHkRdhamv25EX4dECfp29JJvxakx8UOR+A7VKfOA/qJL+Q8xltsQ8wM42uLeI+TR/KoTas60/0C425VfkMG11HYWvqv236qerHPkY+JM5D1291umiC/AbxH+MGdfW1xswz1gttQIeTI6Jz58DY+u2YZvbAYJA6WewC28nBwFV1LoaBTotyo2JnmpTGA5guVpsmXqTNTdJx2KRHLzEqKw1vy1wb/LCRQRYMzPTBhC++qK1DvqTKB9DetDv9Zba0/SB+hnE7Nwkclp8ZJO04Ql3nkl8dF+gXqY9gvMU+Y6psFR8S9y1dZMdMZ9vTj9O5N/Mhwpuo8gHSR6onzfWrfGwT9gFmpqE92o7/jHl11xbkpQWumUKLYnE/1uI75+qgfrlrDfRD+tR2cwtwvUC6ftOOI9iMrzVmnlnxjrYrrriimOiwxbvvvtv6NlAeQdHjLmz89m3Ws5uJSVrx9ttv79fOX3zxRTExUJVHvcOtuSeeeGJx0kknlSGjAXJNDCjFoYceWoYUxQ9/+MOwf+6558I+B/3ioYceKn70ox+VIftYsGBB+Wt/jjrqqLDnkYwUdK3b5Ln1m1vKhR4T4bERNn73+hgdt6fT59WP402PmumWduKSP791+3mdH9At+2yxXGkYeegxY9KoPLbcIzynnnpq2Ne1gxkNbr755uKmm24KdjHobfiXXnppcfLJJxcPPvjgfv1ynOnXz5Bu4uKgOOecc8qQffTjZ+JXArCP20r+B2644Ybwu9dH62I/lm6URb/H3xCHuMjApsdnOK9H6/ALxNW5+HE5yRX7HoWRb+zL5Lcoh/qn0C74VfkzMxrweJTGAMEjjBMX1OXRJKtWrSp/7YN2Zh5DHoLjZ599dsqe4LPPPiu+//3vl0fDA9uiH//kJz8pQyY544wzQjh2XEWdDzjooIPKX/uDrcNHH30U9jH2AfYBow52QntgI7Qjc8cqiFt3bYFNcD3DY5CxP5huXnjhhbCP+zFyL1y4sHj88cfLkAOpu9aomh8dccQRYU+9U+L+Sf9Av0L9y9caZkYoF9zGFlZs9R8qrfyn/7GaGGz2+28Aq/+s8upOBY75rwBhM3XrrRk+rOrTxmz89wWbwDaqVvuxo7ougt3wHxlQ3Nx/naYbZECW3H+KCKfOVeT+sy6Ub65/EZ7e+UNf4j/Q0onudMmlr5OpDvotG23Ixm/KUD9mH/sF2p047Nv4AfKkDrF8aRhxpTfK4r9uKoew3H/1SEseZnTBHrAZ2op2ZON3lb9Q/8j5AP0nFjuRXWBnaV8YJwbxM+ig6nyvfgbdkh/tRdvozre0HXJ5tkF+Qr6e/s4xm6As+jNyUAYySiZ8AXElD3uOOS9bIs9UvjSMdNIBOidf6k5ehFFWCuGS24wetDHtU+dXYoibjifYBe2MPZEftjddbY5tUja2GCOZ6vob8lb5AOWrPgPoR7ZOPWPsA+wDxgHairbATmgX2i3tz0A7qs1yfYHzhDHf1PxW7dzGj3QJ5WLHKbLTKjRnroJzqX+QLqhzDP0EnUpH9D3ixX0JyK/K5zRBHdVf2fhNGfJF7H2tYXLMqoW22Phjg8PQYieFMyJeDAYs4zWzFzk42po9NlOFnHoV2JXSK25sZzMFMiBLOsgA4bEjT+Eczj9Hmm88sOR0qYEghnhp/pRZJ1MVkicuI1d3tQ1tH9PWD+TkS8NULoOeQB/UNTfIUTbx6+zPjA60UzzBySEbYJ+ifoKtkhebbECTr3Ej19cE4XV9mvNNemzrZ+hjcd/mfC7/OM9eyPkPhcVtTX1zfZ0wbCdGFwJx2+fkS8NUbqwD6Qt7SqHs1MeZ0UDtxoYNN/kB2px4qf0DeXGuyg6GRa4fgOqW2nMM56t8QJpvfDGZq599gH3AuEGb0Ta0G2NcDHak9s3ZmWwHm5JNKqyqTw0LysyN9YRxrgrO02+riPOljtIDaVJ9UWdfa/haY1SZFY+OCm435TbaCWMrLr744srbpbldlVu4Y7jVdaIjFM8880wZYmYj3377bbCPiQEqPGrMLbl1t29XwS27PFY2Wx4BE9xWzeNtdejRi+9973vFli1biokBvnjnnXcO0AV9iX6o25/Z0DmPyfSj85T58+eH/eeffx72MUceeWT5ax/p7fXD8APxY2/oY9myZeHxmBQ9Bvfxxx+HvRltaMs777wz+A1so1f7pZ9MTITC4wLkxXb77beHsN/85jdlrLmBHqVoety+jZ8hL/wJPl0+5rDDDgvn8DVdoMfY+PpyyuGHH17+moRHOmKQj/5/wgknlCGTXHjhhWH//PPPh32vxDrg8RDsKGeTyNOVHky30G4Tc/Bi4uItPPrzi1/8Ivv4n/jjH/8YxpO47QWvwJi4oAqPCjKuxY8ljiJtfcBpp50W+vS5554bjicuLsOj9zH2AfYB4whtpnlB/KXuNtcWr732Wtj/9Kc/nZrX8qVJ+n8/85OZoM21hh7zpG8zH2D+9cknn4R5eoyvNXytMcrMqoU2wOD+8Ic/BOfFeyKqFtt2795d/tpHnWMz4w+28POf/7x44IEHwkUzkzYcEw6ql0mpJol6/n2usX79+mLXrl1hkGAgq3qfCmzdujVcTKRbF++UYKDi4uKRRx6ZGkyfeuqp0PfPOuuscNzEsP3AqL27zwzGtddeG/a5C6466CfppBI7Iyw3OTK9+Zmcj9mxY0d5djC4IEaG+++/P4wTbLwTi4uatn7sm2++KX9N0vVco+mCxYwuLL5zwQ1PPPFE2OfgXUjnnXdeebQP3uXEOeY0/KOZfsOF3dVXX13GGF+YP2zfvj2M6fjJ73znO+WZA7EPsA8YN7Ad5rCav7a9tvj666/DPl1wOvPMM8O+1/nJqEL/oh+jI2AeUNVvfK3ha41RZdYttAGdghV/OiULK7lFlKqLGzqOmZ2sXbt2v/8I8/JO7ARbeOutt0JYG+64447irrvu2u+/J/y3BfgPbK8v2ewa/Xfz1VdfLUMm0SCuwXgQ0CGTesrhP0nxi4djNm/eXP7aR91/7XuFu4KYANOutAODIG3adgAbth9IJ9dmvJFd6T+cbcFG+e9sjnEdc0bJz+R8Sld+BhkeffTRcHFzzDHHhLtl+O/0k08+WcZoJvefcDj44IPLX4ORm+OY8YGLQS4qubMtB+3LYhyLcincvfazn/2sPJr8iAJ3f3KnxLDtApnhzTffDHuh41NOOSXsB4H5/D/90z+F+XzdP8/tA+wDxhH+gSQbaHttoQ+daKxN6XV+MggrVqzIzm0Ik38YFO5iJS/drZvD1xq+1hhVZuVCGzA4c0s+t4+mt03jGAhLnRQDVW4iY2YHTJKYrMXoP0J79uwJ+zbwH2P+exJv+o8LE1zOzzTYMV/miSdfmvzqkYUcDGZVCwKpjhhgGGh0EZwOavQzBsZ0Yvziiy+WvyYZZILIlxyvueaa8J9r/nvFRbnatIle/EAqY1uZudiRbcRoUEwfOzGjDbZMH2lrY0Jf5Uv7SM7Wxol+/Iz+W58u0Ile/IwW+2699db9ZGAS/OGHH5ZHg/kY0nKBj2/hv9L4mbZfjpV8+MFYBv1O71CKJ8ttZaau+LHLLrusDNkHefDYjRl9aKvTTz+9PNofvhpX5SeY06R95rjjjgv7YV984Qexr7Qvc0y4+npKkw9I5SY+83kttumuErAPsA8YZ/iKNnNYaHttoS91potL2A5t3ev8ZBBkv/E8Wr9z9ijqrjVyds+iNgtd9KP4i6Lgaw1fa4w0EwYz1kw4n/CiwKoX/XGeak44rDJk8iWEEwNfeDnhzuhFkoTp2Mw+ZAvsAZuZGLhCu+fsZ8JpHWA7VZBP27jTAfWhXtQBkItj5KxD9ajTh/IUvJSTcDbSqw/pZZ9Kw7mJScABfZHzhMdlttWn0uID2FROnG5ikAvx1O6irR9QvTlHXXkBLWmIRznIzZ44cV7IkeYlkBW5zeiC3dBO2AnQxoTl+gbwolxsgHZPIY1sRvnJ1qryGweQnTrIJ6AjjnM6iEGv6COH+pvyFFV+Bj0SRrn0TbbUnygO7ReDHE1tEPdt4rNRRiwD6SmTeGpfIbugPsRj43daf9IjC/UkDfmTjvKQARQW50WdqnSpuGZ0oH1pU9o4toe6dqJ9ZQMptD92o/PYpHzXdKD+QX1Afa1KXoF8ObtFH4THeQr6HeHUV/oD+wD7gFFH803sUO2GDaU2nqL2TvsTbUq40nOe/Jv63TBQX6ZO9Af1kzpUL9KkqL8oT0He1JFz2Lz6GXvC2NALedOXYl0oTuoXqvSborTq/yonTodMxKONY9T21Ef+gjiE6RjUppzztcbsYawX2jC2eKvqKBhveg7DxwCVlg6SM1Izu8CB4XSa2l3ntbUdNKpscCaIbZw6p84/B7pI6yHHnm5xHA2M6Tn2DAiEIQODh5DO4o0w0CAUl5GDvq380420cR9nU/6ijR/gWGUQl8GOfexX2Cs9cisu+ecgTiqLGS2wabUltkt75SaFkNoZWwppNZFimy1jTj9+Rv4iRn0o3WIfUOVnYr+e9rtc2ygdbUC6qnYFztH/c34G++B8Gh7LDPg9yUcaJtBpmaSRvXEeFFd2Ip8Z2xG/c/KjA86nspiZhXaRLbBhn9h1FbQ98aug7bER2U6VfQ2T2L7pJ21sLucDZN/pFhPbfnzOPsA+YJShfWI7xO7atIvaOxeXc7KXtv1uGFA32WOVbadgz7l6EZZu1FNg06pzfI581D/pZ77WmIQ4qSxmejnwasAYM6fBqWuSN8owCOXkJJyBZToHFw1+TYM1aKLQNBExZjaTToZHFfprbvGQSXHbi6WuwKfhZ9qAzEzAjRlV7AN6xz7AzBZ8rdE7vtYYP2btO9qMMf3BSz958XL8HpRRhHcm5L5EyHtTjj/++Oxnt0cBPsrxu9/9rtX7XYyZrfB1cN6rNMrwfhTezaR3XsXwAvtFixaN5LtPkJuXt/MeKWNGFfuA4WEfYEYdX2sMF19rjAZeaDPG7AdOmQkaX/dp+yLOmQDZ1q1bVzz88MNTLxllz5cJ//mf/3laXzKvF8B/8cUXYV8FsvHyWL54a8xchhcJX3fddZVfERsF9CLhX/3qV6Hv8rJl/A5+5u677y5OOOGEcLE9Xejl8U0XJvfee2/w4dMpmzG9Yh/QO/YBZrbga43e8bXG+DGP29rK38YYY4wxxhhjjDHGmD5pXGibN29e+csYY4wxxhhjjDHGmNlJF/eiNS60/dVf+elSY4wxxhhjjDHGGDO7+ctf/lL+6h8/OmqMMcYYY4wxxhhjTAf4djVjjDHGGGOMMcYYYzrAC23GGGOMMcYYY4wxxnSAF9qMMcYYY4wxxhhjjOkAL7QZY4wxxhhjjDHGGNMBPS+0XXTRRWEz+3PVVVcVhxxySPHnP/+5DBkf3n///Sn5Z4qXXnopbHOBUdB3v3z66afF3XffPSN2/vDDDxeLFy8u5s2bF/Yc44vOPvvsMoYxk8hOsZM33nijDJ2EsEFshvyWLl0a7JA+TDmmd/Ah6G6YfhBf26aNuvbJdfY3aqR+da6Mw8YYY4wxw6TVQhsTYiai4uuvvw57wpouuJlkrlmzpjyavSxcuLD8NX58++23xZYtW4qvvvqqDJlesI89e/YU55xzThkyu5lpfQ/C0UcfXVx++eXF1VdfPa2LbVwMvvbaa8WOHTuKnTt3hv726KOPFs8880wZw5h90Me2bdsWbCVlEF/NmHfZZZcVL7/8crFr166w0Ltu3bqwsGJ647HHHiseeeSRofrB+fPnl7/q6don19nfKJHzq7feemt51hhjjDHG9EurhTYmxN/73vfCf3zPO++84vzzzw+LI4Rxro477rijeOihh2bkDphhkVs4vPPOO4vdu3cXhx56aBkyPpx66qnhP9kzARN9mEt3Sc6kvrsAG7/mmmvCXUHT1a9vuumm4qSTTgq/Wex75513wjZMuLNj1O9G6RraczbcoXXiiSdO2UsKdsNCWT+sXbs29F36ANuDDz4Y/D42aXpj1apVxRVXXFEeDQfahfahrJjUzrvwyfG8oM7+RomZ8KvGGGOMMXOBVgtt3MGycePG8Pvxxx8P/wHlv5+Eca4K/sv/yiuvhP8SNy3IjQtM0Fk4NIODffziF78orr322jLEjAtcmPL43L333luGDA/uIpqJu//uu+++8tfcYbb46WHBXU9m/OnazlmQf++998qj8WCm/KoxxhhjzFyg1UJbepcWj47qXSZ1d3Ddc889xfr168NvHq+ZDfDInCen3bB69epi+fLltTZkRpcf//jHxV133TX0x+Z4DGu64U5L/kkwl+DC+4YbbiiPTA77/vGnazvnn288TjxuzIRfNcYYY4yZK7RaaOOi8+KLLw6/mVDy6CgQpkf/Urj45r//PLKxcuXKcIHy9NNPl2frYeJKvtwxw+MdTIx5TI2X9eYeV6MsHj3kPBu/04t/HgPTC6zTjUdigXz5rXAeJYkfLyG93gmlOMB/s9MXKeu8Nj2Cxl5hcd7Ul/IIZ1+lV4jz0CbIU2Eqk7orbzb0g06rSPMXagM25S16kR9oH3R55plnliGTEE4dyIMy2JSv2p5N7a14MZznMR7agzi0WxqHMnSePe0nu2Lfi/3loLzYJuP8UyQLW9pH4rLZkCl+WTXxKUdyyX7RS9rGOq96p5v6DPGa9Aff/e53w/65554L+xykU5nkq7qoDk1lEXbaaaeF31wcc0wedbSRn7rGuiBP6Yu03GkJlM15pY/thjTouQ7pnPikIw3tBYTFW1pvbYP0CdLKlgmLfQHxSQeE8yoAkJ4pU3CePAinHtRJ9gLoTvoEypSe0CcQR3kgd5w+BbniPoidkx/HgvOqC3uOm4j7S0pdfsQnHFiA5beOq0DfahM29CN9i2HqtW3bi9i2JYvikBflkZ68+B3LQDx+K73KTJEdE4c97zGrQ3rXRp5pmNqScwqjnNSGoMnOhXTBVjdvQS/HHHNMuMNfdiF5YmLdS2cxyB7bAXHS9okhvuyCeNIJ5UBTexBW51fr+kJT2egktnt+xzaJXORJPm300tSH6mStgjxUB+Udb8gZ+wr6GHkTX3VJ80DHsa3E+Un32JXCZHfkLZ1AbHs5nRhjjDFmTNjbgl27du3dunVr+L1ixYqwAWGcy7Fy5cq969evD7+JR1GLFi0Kx01MTFr3btiwIaShrNWrV4c8FEbegrjkK/nYL1y4cL+yVL7kURrC+C2WL18ewqkTG2UTZ/v27WWMyTiExZD/kiVL9guPy0h1tHHjxv3qQP04Vrn8Jh3xqlCdKDeF9EqreOguPlYbirReyCH5YyQb+Yh+5OcccTZt2lSGTIKulZ58aTPKisOQnXRstDVbDDpRfWkHtY3amjw5VrvqOE7T1v5ySC7pSDpHx0L6pmx0QZxUTnRJPmor2ZTqy3nlTVrkjPVC3BjZd6qHtD5N+otR2VXE9VJdkQEZoU1ZqiPpUwiP9QpNebJHP3Ec6RWdgnRD2UKyKx/ZQx3olvaL+4bkjWWTPgTlUhZpBukTpFVd2FM2e5XLXlTpmXqSn3TBXmVIF4QpT9KnNk0Y8hImvcmuc5BvHI/fpJe81JnjWK/EpVxBmYRJbuLxm7DUZtrkB7m0OdQOKjtX7rD12kvbK16VT4xtkD1ykB96A/JS3NiuVQ8gXVxfyctWRdwWcR9RWpUvkJv4ENsQ4YLy0zCgPgpP9RzXIwdxUruQDpGR3+SnusR2Rb0oR2VIZtUjRyyb5O3Krzb1hbqyyZ/fxFFc2pwwaPJlqV7S/kGcWM9NslZBHsgkfSAH6UgP5KXyqCvn2ZSG8/zOlR3bJH2RMNUBkI0w8gPOKR5h5MOeuqf5GWOMMWZ8qL9KzMCEQBP5Kph0MElgLzSJjSfLdWiSk04ymNzEEy0mJWkcjkmryZYmMTGazMYTICZUcd0kQxxH9UjJhWtClU76iCvdMGkjTqwrfhOmyWkVmtjFk2fSxvpB38TRBRRwPo4DOflzYUwACZNO+pU/zSdGek9thTDaKEZtLdB1Gkc6QF9AGuwzhvOa+IJkaLK/HMRJ0yFTLJd0G+tN9hLrFjl1wQTSWwzHaZ1lG4L25ziuI5B/XJ82+oshbipPiuoa2ym0LUttkcoOhPcqP/s0jmxCMubsk7A0XU4nMciW2kKbunEct7vi9dMnlDZnk3GeOVnUv2NZQLYa10U6i226ruy43XIobarjtj5H8pBPDGFx2W3zgzRtFU0+YLr0WhePcLU955t8ouRAxpg2fU5ypPabG5tTpKvUDlLfBRzn9BTXIxcGpCU8Tq/2IE0dxEllkb7iOqsucdnYSqoXtQ/xq5C8aZw27QE5PUi+pr5QVTb5p7bGMXFlN73oJWe3qltbWVPajoVQlRf1TPsLEJc00ovqGttPTu9VOqEMwuM6GmOMMWY8aPXoaAy3xtc9SgG8aHhiIrLfu7f0DpNeXzB+0EEHlb8m0e31All4T1R8mz7H8Pnnn4f9IYdMPnajW/7hb/7mb8pf++BrW+Snxxv+7u/+rjzTHzx2MDHxKm6++eYyZFIGvu4l3fzxj38M+8MOO2xKfn7DxEQr7Kv49a9/Hfa8C0+QX/y+mHPOOYermPAVNOrGYxBdvnuqX/lfffXV8lc1CxYsKH/tI32fm+xDj2a88MILxbvvvjslC9u5554bzqn99YVYHv3QYydVNNlfCnJQ7x/96EdlyCRVX3OL63PEEUeUvybRF/OuvPLKkC+PqVS9WyjVy1FHHVX+mmT+/Plh/9lnn4W9wD5j2ugvJi23jvTLjL2W1YY2efIxk5/85Cfht5BNpDLGXHjhhaFt6dc87gN8dbKOX/7yl8Ef8TiQyo/T8FGJFStWhHdYxnV+9tlnQ3kp/fQJkdrkddddF/Yffvhh2OdQ/z7uuOPCXqCDiYvA7IdhcjaR9iPitPVDqS0P4jNzdJ1fGx8w3XptavtefGLqp9r0uaeeeirsGY9i2nyZkz7JfILxS48Nssd3UVf1RcqKx9Z+idOnde2HuM+m/gXZsRX0FesPfcKXX34Z9nV06Vd77Qtp2W3mY6JOL730oV77bduxUOT6AvU8+eSTy6N9XH/99WFf9zqFOuL+gU7wB/Dxxx+HvTHGGGPGh54X2ppgAsxFYzrZ0jvemBinF4CDwLvf1q9fHxaT0k2f9GdBikkUC1LIx/bEE08US5YsCRe6gnAWM5YtW1accMIJxe9+97vyTP8w8WLSx8QMkEELZPDNN9+EfU5+tjqYiHGRzkWZJtB8FVaTM6H3oLz++utBV8uXLy/PDM4g8g8DPtRB/XKyvPzyy2Wsyfeg/OAHPwjyj/KXBLkQY3H0jjvuCB8foP36AVshLXao/seeCzIWg0Rb/XXBMMoapvzoEH2xcM97nmiXJl/GhdPWrVvDwjI+CP+SXuziK/FjWjCnjXjfz6ALBk20WURQ/86Ru9CcDrr2OTPhw2Zar7m279cntulzTQs8TVxyySWhj2gBg3/m8Y5PFiX1Ti76D/+UGCf0QQJ8RE5/8fykLYP4wEH7Qpv5WFf0K2vbsbAO6pkjXTgflPSfDMYYY4wZHzpfaGMCzIVCbuKzevXqEOf+++8P+y5gop3+Z1JocYuJFQte/CeU/3jqv57xpJNFNi6c+a/+jh07wmJV7u6RXuGuFGT87W9/O3WxgTxCdyTkLkQkfx3XXHNN2KN34qdfPyOM/2b/4Q9/CHfScGdbl/Qrf/oRhK44+OCDQ/vlkDwsdjzyyCPFW2+9FSb/cXt0xebNm8tf+2Ay38sFJ4tsZ5xxRvj4CLaa3g3SK5dffnlY7MFGWPxmv3Hjxv3ybaO/rhhGWW3z5I6xFHyAXuhdBbZCP2LxnLJ4oXjTYhsXy7QfF9P4IBb4KUuQJ3fssGBOm3MHbLwYP2zSu6JyfPTRR+Wv/cG3TTeD+syUrvMTbXzATOtVdR/EJ/bSj2O77wX6EP3mN7/5TciDRZa03zB2dz2+DRvdXfXFF1+EfQx20uRbcgziVwftC23mY71Q14cGkbXNWNjE22+/Xf46EMnWFbITY4wxxowPnS60MQHmbraqx6muvfbaMBHjP9FMjLuAu8+YaKcTK/7Lfeyxx4bflPXoo4+Gi1wt+hE/vmOEW/P5jyYLG11CGTfeeGPIm7vP+M98zA9/+MOw51x8EcLvDz74oDyqhgsQ/nuNDljMO+uss8ozk3CHGzrv6gIkvROjX/mPPPLIsM9dYAwC7cciCBeOMdiAZEdXXLQN444h2gN96+JPoA8en+rlApa7P/nPuXQ8KFdffXVx2223hYsw+gD79O7HNvqLQUZ02Q+9ltWGNnliq/TH1Gfccsst4Y6eKrjjRzZOO5Kei7U333wzhOWIvxqHbeD7aNP0USAtrCE/+uzFTtqSLupI7tRnxOjxVRY4UrjQxLdNN4P6zJSu82vjA6Zbr01tP4hPbNPnvv/974d9v4/UAY+7Us6ll1469UghCyaADOedd174PU4wLmMr6C62FeAOPWypVwbxq4P2hTbzsTa06UODyNpmLKyDBV78eFpP+hly5x77F3v27Cl/HUhqA7oTOp6/5RYWjTHGGDOCTEwyOoGXtU5MPsLLYOte3Doxmeee/rCfmAyWoQeil/dOTKLKkMkyyH9iIjNVBi+25Vhx16+f/GpT/BJdwji/fPnkRwDYOE+4XlKrF+QiF2Xz4l7yI4y4ekktvwnjJdb8pg7IonrFHx0QnEdGys2BvKSlbpKrST8xuZfrCtVBdSV/6ZA6SX7CUvmlN9IobZyf4vYjP+eUT4rKjV8UrviUobYHyaMXLcdtwZ68kCnWPXVnIw064DzxiaN82tpfDvIgLfGkD9LJ1mIZY31TX8KkEx0jA2kJR0bCKIMw8uK4Si8qExSPPNiIQ56Uo7SxbFX6Eyqb81XE+akPibZlEU6cuC1AfTaue5s8SUfbEAfbJQ7n2Qu1P+fRNRvnyVNthm6JI5vJQb7kob6guuT6BnJyLm4zoXT99AnJiewqlzB0ENeZPBSP+uuc5KIexGHjN/Hicqkr8WKbRgbC4rYjDTITntODUFryjcsByucc+SCf2ibOT3poo7M2+UmPadockr3KB8B06LVt23PMRr5VPlE64lwM5ZK/yiFf4pBWEEdlqD2QR3UjTVy/Kkgf5wscU+8cVXqSrLLzuA6xHPLBsa5ykBbZyA89gfQV2x95ExbXIbYV0lAW58mriljeNF6b9gDCiRPrBiR3VV+oK5v6UQ/lS1ryi22G35zvRS+SI+1DTbJWoTSUxyZZkYn6AXmo/DQ/jglnkzzqV+ovoP5HGfymDNWfMpWWcMKoj8qX7SkOKCzWnTHGGGNGk84W2phIMAHQFk8ORHy+Lp4mHWm8XBgwSWPSQpgmZTGaGGpymG7KRxMg8mAio8kUddPkh7KYoMUTqqr8Ysi7buJMncmX9MhJOb1AGskYI3nJl3pQJ2Spkx9ZgPzUruRBXpyjLNLG5fUjP21G/jGpHXFc1fZpWCw3E1bqSDjlxLIiu86hC84hc1zHOF+2KhmqoK1jfcRx03woL1fvVP/kQb4cI3eVTGmY9IJNI4vqHm+UI5r0JyRLehESE5fBJllEU1lpejbyqKo7tJGfdo51m164EF/n0TWk7ZRLl0LZ6FxpUluIUV9Nictk47iXtlc49ZBNVslOHM5TRqwz4ioteo0vCIHweKNctjS8Su6UXNoU4kgm9Br7nLY6i+klPzbC6qjzAWLYelV4U9s3+cScPmOI39Tn8BOEc554qgt5aSxqAtlSPZKWfFJSPcUyp3Yex2OTXHFYWucY6a9OX6k8bAJbQd+EkUeTPtJ80vo3tUeani3Og9+yl7Qv1KUD4sbtjK5FP3qJ5cj1oTpZq8D+iSv9xBsyVfWnmNie2cgPeVNka5RFu5IP8iK3xk7pgL1kytVXY26uHGOMMcaMFvP4MzFwz2q4vZ9HJtIXJfOIAe82g65f1Gua4RGIiQlnMXEBMPQXv891sHUel3nggQcO0DWPq1xwwQWV7/WpgkeTJi4KwhcLzeDwmCkfYenlEaY28E4j3iU3cdHW16NoZnxx2xuzP8MYCweF1xLwRfE5MB03xhhj5gydfwxh1GAxhy+e5t6ZwSSLd4WdcsopZYiZTnjPyoYNG4p77723DDHDgvePsaiZW9Dk/S+8W6cX6Fe885D3LprB4eKP97d1vchmjDFmH12PhcYYY4wxOWb9Qtv//J//M+z5oih3tvEffm3cQfL666/7P/0ziO4yTF8qbLqFRbG77ror2HzcB9A7fSO927MOFoV4UTdf0sxdrJh2oHu+eLd48eLimGOOKe64447yTLfoRfi5L/iZ2Y3b3pj96XIs7Ipt27aFfdNXr40xxhgzPsyJR0eZRN1///3Fli1bwpeiYMWKFcU111zjRbYRQRPMXj6vb9qjx6SfffbZ8MVN4L/6V1xxRfhyX9sFM+5k46uIfK3Qi2yDwWNKfCHwkEMOCYtsw7ibjQtHvgwb48eT5gZue2MOpKuxsCv4Z0vM8uXLwz+xjDHGGDPezImFNmOMMcYYY4wxxhhjhs2sf3TUGGOMMcYYY4wxxpjpwAttxhhjjDHGGGOMMcZ0gBfajDHGGGOMMcYYY4zpAC+0GWOMMcYYY4wxxhjTAZ0vtPFFJz6TvnTp0uLuu+8uQ7uFr/Xxpb5h5T9qoE++TMXXU0cFfQp/rrTBoPC1TnS1ePHiobVj1/0Cma+66qrQzuMINjpMfY8atBXtjw9uS9t+PB32a7qnH5volbrxiXLXrFkTZCAOtkb8URy/8Z/S11xkFOZV0zHm1NlrDF9C50vQ4zr+9UOuv2IXTUzHvN+MPtjAuMwRRtVm0R0y0f9GcZycaeaiXzbjTeNCG52eDt9mwyF88803xeeffz712fRhMH/+/PLX3GDBggXlr9FAE69XXnkl7E0z3377bbFt27Zi586dZUj3dNkvuOB57rnnioceeqgMGS+YQD3++OND1feosXDhwvJXO3rpx9Nhv6Z7erWJfqgbn66++uriyCOPLHbv3l1s3bq1ePvtt4sXXnihPDtaYONbtmwpvvrqqzJkbjHT86rpGnPazKe0MP3MM8+E/Vwh119///vfl2ermY55vxltxm3ONYo2y5zssssuK15++eVi165dYUFp3bp1wTeaueuXzZizt4GJwXbvVVddtXei05che/cuX758b5p0w4YNIRxIw/n169eH41GDuoyqbKtXry5/jT5dtvEot0m/pG1J/dAZ/WNcoE+rX48b8kPD0vdssdm2/Xgc7Xdc2bRp09jrefv27SNtL7mxNje3Mc10aa8zNebk6oAtjOv41yu99te0/5CO9OM0Jo7TfHsckA105Qu6ZtRtdsWKFbPa33Q1Z55LftmMP413tO3Zs6f4r//1vxaHHnpoGZLnyiuvLM4888zyaLR59NFHy1+jxYQTGts7iAZlVNukXyYG8OK9994rj8xsZLbZrBkd7rvvvvLX+PKnP/2p/DV6zOWxdhjMBnudDXUYhF7662zoP/YBc4txaG/uqJ7NeM5s5iKNC23nnHNO4yKbWLVqVflrf/bu3Tu15YjPV8VJycWLw6ry2759e3HjjTdmz0FVOojDc3EUljsnquLw+5prrgmPreTOxccxOlcVJw2vigc6VxeniqZ08fk0TtomuQ1yYZALgzg8PSfq4qRhuTg5GND/43/8j+F3XRqda3O+Kk5KLl4c1pRffL4qDtTFS8Oq4on4fBonDcvFidH5ujhQFy8Or4rX5EdEnD6NVxeWOwdxeBonPRYKrzof0zZeSpwul7bpfEwuXhxWFR5TFQ5xeC6OwnLncqTxmtLG59M4HG/YsCE8zps7n0PxcvFzYSJOE28iPs6dF7lwjr/++uup37nzORQ3lwbanhe5eBxXjbUpOp+LVxWeEserilsXJz2Xnoem86IpTl14Li2/6+xVYblzok2cmFz8NEzh0Oa4TZ/TuarzOeI0uXRxWC5eHBaHQ1V4jjhuLj5hdf01hnNt+o/OtTlfFSdHXbpceFVYXR0Uljsn2sYRubi5sJj4fC5Oej4XJ6UpfhpeFU/ofF2cHHG6XNo4PBdHYblzKZwfts3GYU1xqsKRLz6OUVjuHMThVfGqwquI47ZJWxen7ZxZxHnVxR80Tu5cHFYVHh+L9NiYwIRR9Ay3bNYljW/H5XZ04s+bNy/s/+///b9lrElef/31vUuXLg3nDznkkHBrbxonZteuXeEx1SVLlkzdgpqGVZXJowGEIRt7NuXxl7/8JeSxePHiEL5o0aK9Dz30UDgHGzdunLqtl/w5v3Dhwr07d+4M59etWxfkJy3hK1euDHLFUFfyUNnEkWzoALli2YD80Qnlpbdj/8u//Mt++fGbMgTxKQN5gLoiI8dPPfVUCBMvvvjiVN2RBV2m5aXEbYx8HKMf5IqhjtRB+iFvyZlrk7PPPnsqjI1jZInD+C35OK8w0cau6uL0orsY2ot4sZzIB+RBGHlTb/TNMeWmtJE/ZpB+ITimzpSnOKRlH7Njx44D7I4woAxkxR6ActEZG+H0s5gu2wAbRl7lRVrpW/TSz9EfeSie7LrOj6QonuJKFvY6p7Tkr/Zhoy7USdT5oFRXoilPkAxN/Zg4nIv1CU222otvoQziUY7kSsP4LRSuPtbUvrGeaF/qSXraFOpsO0fqn5v6NTpN80d/Ys2aNSFc9WSr0hWgm7i/IoeI65rCeCUdqTyViZ216QeQG5/Yx/nqN7Lm/JRAz5QT1ycuS/5J+VEm9RBpfaUbjmN/gQ3G9WUTsgdQPeK4Ij4n28vRpv/VtWFcZ+JwnnaJabIpoF/Qpuqn6CTWXV271M1t6uwV2bENpSXvVC7VL64/8dhXofFeZVIeYfxWuNokbifqlbPXujoQhix1faAK2pm4ypN2wcdCqu+qsTmuq+ogdC6WN0eqY8qkP2gslo7YlB9bageiqv+Qj2Ssqo9oGjOqqLN11UOyiViH0lOdD2jyQ9DU57Az9CA7Y9O4QH60P/VVHsTL9Y26/qN25RxxyJf86ojTqNx+fKjAxpFLMpA21nMVdX0D6uY60Kv9dGGzdXOD1K/wm3zZQ9O8JPVfKkOo3WJbiPvwoOXnaDsHAPJHh3H+2JV02MucGZrmjOTThVycI1x65zgN47dQOO2FPL30FTN3GepCG52USQzHdHLCMExBZ6ITyXnm4qQQV/Ew7DSsqUzJprQCh6R30bHxm3h0GI6Vjg6vzkjnpWx+c04DhY4pX1BXOiD5gPJDlyKnV/JEfsKVFnAocRnIocGEsoD4yEsYMuE44zDpnX2cP3scRlxeDtKg74suuijkr8EiHhCB8nJyKg7lSEZBGPmQVtAOOEri8juGuNJ/G7tqikP5bXRXBXHitgXZBbbGb/JT25K/mIl+gT6pm8qN+0BcD87RBuQD7NE9YTqmLMlBHuyxJ8I08EOXbUA/JYw8gHgqk9+il36OvpggsMV1BMWTrqtARvwEcck/hvpQPnCOMtAdSM+EQSob5bLJB3FOehFNeQrStOnHnCNurM+mNiQ8TsO+ybcoj9hW6NuEUccY8qF86baufYH40hP1oQ3QIW0s/cSyooO43VNi/9zUr9v4bMjpOQd5I1uqexHXNSbNnz3Hqmdqa3X9oGp8glw9kFVycl4QTt6xbiiHMLUtfogwta38jPw+5aRtG4dJT5AbayENJz0yECY5BGWob+UgPmnr+l9TG6Jb0qvO2HPsj9vaFLYZ91O1jdqA8Fy7KJ50rGOVBwpL2x+95+SSDNSHOJJL9SNOXMcU4snmsEkh+WO/AcgnP1tlr1V1IKypD+QgH9Kq/jqObUHyElY1Nsc6SesFhKttcnBBiazkQV51+VXpIEeu/8R1rJtr9DO/gTa2Tv2oL2ExuTbP1YE8ad+4DPVZ8oY2csR2Fo8Lse4Zb2Obiv0CNPUf8q/zDTk4T32UhvTk2Y8PbTvnSuFcmo5j9Q3kUhjlIgeb5jr92s8gNktZ6I3zwD72A3F7s0dvzKPIE2jvXB/UvEQQlrZhmz7cVfmCOHEbkE+d/0N/uTYhrVB+tGUd5EG8WNfpnLFLuRQmXQL6TOMBMpCf9MN54jX1FTO32d/rtCTnsGIwttRwgU4QOxGOcZqsOmtrY6TKP+6wbcvMpVXHxqFJDn4TFnfc9FjQ2XEEgvRpGaRLZaPDsokqvZIP4cguyE8Dk1A9YhmVJ45B4BDi/KQTrfKDnEYdpEllkKyqK/nQptIrG21OHA1kuTYBDRyxLcgpxrLxO9Yt9W+yqzZx2uiuCuLEdgfSDYOCUJultjLd/UKyxXUFBq84Hm1CXrFsHJMW3UBVPckrLqOrNuAcead1TG1Fum7Tz5EjRrYocrquQvKmkxrqpnohGz4EmQHZ+M9bXCZwHMsaI12JXvJs6segMOkTmtpQeurVtzCpTuuJjLRzbAvIJDtr277SE/Fj2th2jip7Jyy2D2Ro47Nzes5BPHSNnIIJdExqE5D2aUCuNB7HTf0AquStCpdNxLoh37QsjatqJ8ZKLk6BOnNXQ5q/6lvnLyCnF8iFqx7pHSfE1QVqDuRu6n9NbUgZqV+Lz7exKR2n9olsuhCDXLu0mdtIP7F+0bnqpQ0/QTzaGpQubivI2WeK6qS8RC4tx6nPSOXNhQFhbfpACrrmnxWyD+qPHLFs0nfavrRbHA/ZaYO0XqRP2z4FWdFJCmVQNnoUVTrIgSypDtrWh+N+5jeka+M/c7Ll6paL18YPtZVD+oj7HRCWlqFxRrTpP8hf5xtydOVDOYddpeXn5ucpbfoGkE+sT0FYP/aTa2+1UZPNonPixGWqzTQ3kI3pWMg2muYlQFiqh7Z9uIvyU4iT2iryEC5kG+lYqHiSR7pGzjoUDxkFecQ2xfmu5IJ+5psgm6rrK8Y0vqNtEA466KDy1yQTxlz+mvyM8YQDKP7Df/gPxV//9V9PbbxAfsIJF19++WUZszfqyqzij3/8Y9j/m3/zb6bk4DdypJ9VzuV3xx13hM8OT3S24uGHHy7+3b/7d+WZSd54441Q1x/96EdlyCR8Op2tV6S7k046qQyZ5Oijjy4mnEM4R5kx8Xv2jjjiiPLXJKeeemoxMQAH+SacCJ4qfFaa8CZSGS6//PKw14cAXnjhhfD57LiNaXN0+7//9/8Ocar49a9/HfZ88l/wSe4Jh1jcf//9ZUhRPPXUU1PltrGrXm2vTnf9sGDBgvLXZJvFzFS/eOSRR4qJQeOA9zGefPLJ5a9J+IT72rVr95ONY2TjU+kxvN9RUE9sCj7++ONO24D+y7st0v513HHHlb8m6aWfp3o46qijyl+9Q72x2VtuuaUMKUJ56ETl8BsfcsUVV4S+e/XVVxc33XRTOJfSxqdBL3k29eMcbdqwX99y++23h7xjPzZxsRPaOfYHr7766pSd9dK+kPa9Xmw7R5t+3YvPbuLCCy8M9br44ovD+0/Q7QMPPFCerQab27FjR3k0CfaZo8t+UMdDDz1U/OQnPymPJtG4Kl0yVuLr0dXNN99cnHfeeSE8R52/6BX6An3u2muvLUMm+y+ceOKJYZ+jTf9rasNf/vKXwQbvvvvuUO/4fFubUn9J/TGyoeM6muY2VbQZ99uOOTmQf+KCKfRZ5AP2tBPvWkM3kPrZfuinD6DriQva4m//9m+DjBwjV46msZny77rrrpAeHyroC7x3qg7Kzunz+uuvD/vYl3bFMOb9w/CfOZr8UD9yxOOCSG1KOlPaNv2nzjdU0ZUPbTvnytFL30j7Qr/200RTH+xlbpDTFbSdl6T02oe7Lr/J/2GrkI6FfCARHn/88bBvS9s5Y5dy9TPfjKnrK8YMdaGtjm+//TbsX3/99eB0063NIk9XsHgDOTnYmsARMNj9+3//70NeVYNGV0h3OdIJQFs2b94cJhg/+9nPimOOOabYuHFjeaY3UufHC3aZTOf0Spl1MHkh7bp168Ixkx30ywDzzDPPhEGCbffu3SEutLGrUbK9lJmSjUGmDQw8tEdOtqqPoYh4IOyynm0WQWDQfj4I2Cw6ZtIE99xzz9RCsuBCm8nFnXfeWfz4xz+esvtB6DfPtB/naNuG/fiWs846q1i4cOHUgjoToNNPPz1czPzmN78JYejy/PPPD79h0PYdxLabkK5y9Ouz8XnvvPNOaCvyoJ23bt1anq3mv/23/xZ8JgsnjF3YJf50zZo1ZYzRhMUeFqvOPvvs4oQTTij+x//4H+WZ4YJ+mYhz4Svbpf9edtll4XcdTf2vqQ2Z1NO/XnvttdB3qL989TBsKqXfuU2bcb/tmFPFJZdcst+F0GOPPRZ8An4D2wbaSRdW0w0XiSxM0p60O/roF+rAxf9/+k//KRwz7+ECummcRD852iyIDIN+x/3psPU2TJccbfpPnW+ooisf2nbOVUW/faNf+xmUQeYGXcxLcrTtw8Oe9+ojKil1/4Rqoovr0V7k6me+aUxbZmyhbf78+WH/f/7P/wn7GCYR6X+Fhon+m5EbpHRhXAcDF/+d5fPoOF0t+qTkFpaoZ5v/KuTYtm1b+etApN+2MNFH9v/1v/5X+A88k1gm2P0iHRx88MHh7gkm7CltdMt/7RhoiMtEmrsLuAsAmEQzyY7/q9vGrkbJ9lJmUjbdGVAHg9Fnn31WHu1Pm/YE6jiMeu7Zs6f8lWfQfj4I2Cy6++1vfztVfuwn+E/tmWeeGQZy/ETuv2a90kWeVb4M2rZhP76FNNyxwgIQ+uK/8PxXk4kXx0y8+I+lfAEM2r5d2HYTXfpsoH24iwEfi/xMDpv6DnawbNmy4E/57zb/LUe3TXc3DZtnn322/LUPLgxfeuml4JtYhGKB8JNPPgny5u4UGRaUx0IHd6WyeLZly5YQVkfb/lfXhoybXDySnotLFvv4b3/sq9vaVHw3lGiy67Zzm5S2436bMacK9LJkyZJwIYSdcEGJfPgN7kyinbCXQS74+oU6srDK/IS27UIG3XWxYcOGMPfhuA11T02kd/IMm0HH/a79Z446PySGLUeb/tPGN8QMw4c2zblyDNI3BrWffhlkbtDFvHOQPjxd817GuxzYcq90eT3aRq5+5pvGtGXGFtpwrtyayUSOCZEGFPZMIob1n4kcP/zhD8OejsWAKln4/cEHH4TfdTCpY8JHZ4V0cKQu1FWTvzh/OnRu8prmEUN+TPrlFGKYAPDfql4GLwYnTcLl4HA63CbbK/pvPI4RzjjjjCAj7aw6sUcP+k9LHVyc8FgTCxTUDV3JKaJPJkWxrbSxq+m2PeXfhpnqF0zQmKhRZh1coKN3Bp5YNu4gOPbYY8OxSAc47Am7pY5d1vP4448P+yeeeGIqnxyD9vNBwGb5tDk6pnz1D8GdIiwoS8YuGCTPtB/naNOGg/gWPb5K/robUv6AMMqWz4VB27cX2+4VdNGlzwYmntQN8IvIjW7efPPNEFYF9SHeW2+9Vfy///f/Qh4zvcjGf451x1is+//8n/9z8YMf/CA8bs55xpOuUXlNaKGDxTM9tlNHm/7X1IY83iX5sCEujMgTfbS1Kd0t8l/+y3+ZKos86bNNd6Y0zW2qaDPutx1z6rjuuutCOX//938fFhFAfoN2qns0bpjwWBIX5+rTbfVWB36N9l69enWwA46bwNdiL9hVzIcffhj8ZxcXjr3Urd9xvx//GefdNNdU3CY/NAw/nqNN/6nzDTm69KFt51w5Bukb/dpPSq8yDzI3GHReMmgfHrT8JnRnt+4iFvLrTY+3p3R1PdqrXL3ON3sBnaf+wswhJgygNX/5y1/C54xJxvbUU/s+LxxDOOcnBq2p87zYcMJgw8sF9ZLDCccx9XW7iY4UXjQ4MSk84OWhKbn89aLQpjInnEuIx4sUKUcvZuQloshCfF5ySfjERHDqRZOqN3nxO2aiA4Zw5CJPvSSTulBHiOuq/CcG7P1emKh0Ew49/KZs6oJuFC4oh/yoB/IQjxeRIsuEIwlxCOM8aflSksLIh7B169aFY2RALr1glPzQQ9OLVaWv119/PaRjT/nxC5bRN3qkPGShTOo2MSEpY1S3ici9YJXfhEm/MW3sqilOW91VQVrplPyJG7ej0uoLVpStsDby5xikX6DPtD0J45j0lI09Ylu0sfJENmSM25wwzhNO/uRFG5J/3IZdtgH2RBi2RZls6k/IqXKb+jnpSMN56YYyyINwdANNNpuDNNSVOqbIximHMqQLwtAT8tf5IGRNddUmT0jbnX3aj2MdxPbb1IaUwblefYugTNKjO0EZyKE2i2nTvtITMsW0se0U6iQ7a+rX6ATZKL/KZwPxSEvZ6JctB/KRF2WRF+1G/oqfswmgr8gOtdGX2GRXbfsBYchJGPUXpMnZC+T8VKz72I7Y6zznqA/tRh0nLhxCGPpHZ+SV1pewnL+I24zf2AcyU984fQr5p/ZYRZv+19SGxEcfshfic1723Nam4n6BHqgz84+4Hrl2IR/qWze3ydkr+TaN+9RfMlFvyiRMbUC+uT6eIluO4Zh8UigjZ6+5OqBPwsinrg/kUBzqTZ2oO/kgq+rVdmyOkZzqF01QjtpQOmZPmNoP6vprDtlB3H9y9pOrD+XS7oTFfZ261cH5NrZOfsiBXNSVverGOcXN1aHJD0EbOQij7ZW/9NFkU+gQ2vQf5EJGyYCMyFXVZ5BN+XXhQ9vOuVJU17q+IT0Rxu+Yfu1HsvVjs7FdEJcyKVtzA9JyzHnyVl6iaV5CfGyV9LIN5UEcykaeqj48aPk5kCGWB8hX7YcMQrYqW6fNsKN4nodNE4dw2goZcmAT1LVqzijb6EquGPKg7HhcRE7ySHVFfm37imSTfzBzi54W2nCsdNZ0i8Eo0/N0nFwY0OHoDIQx8YsH/xxp/sjUa5k4R45Jm3YoZOAcMqlT1OUFyIzTI5y8NUiSV9yxqGucf5wHEJfzsQNNdY6MgvTSHRuDZlxenI6NtGl+HCsf1YG96lEH6ShT6cgjN9iRD45N8UiT5l3VJsAx4SmUVyVjG7uqi0NYvFXprgrZhGwglzZnt2Im+kVsT5SJDORD2ykOUB/akHiylRjKZVBhH9tGnIfoqg2wA+RQechM3uTJJDi2E/IhnHiUrT5TpZs0jPRQZ7NVkAa5UmTj5IdslEs8jklTJZvInWvKUxDe1I+r9A7ErWpD8uac8pa9tNUXeUvfgglPXH5KVfuC5NeW5t1k2yk5vZBnHMYmpA+FU1YsH8TtVlc+5cTlU2dsXShcG2UD5RFXOoo3JpmykXgjbRqWlq+wXFw2wlPdkF4gl/JL6wLognO0C+d0AUIadBbny5aTT+VJB6SXvcbx2EifQrlc0LShTf9LZUzrjX3E9sJvtaPguMmmgLKor+LEFw5V7aJxjDD1W8pCTpVRZa+EN437sezkiX7IKx1z6qDMNC5y59ov1jWb4qR1IL84HlsuLFcGyL6IQ77omnxlb6m+2arKTKGPphd9dRAX3StP9I2eRa5ctlzZIu0/vdaH8uN2Vx9sgvRNth63pewU+UhHObLBtA6C8Dh96oegSY7Uzjiu0kcaFttkXf/hOJaB39JvFdggcclzUB9KfNk04XVzrhjpXXmlfaNKTzH92E/a3r3aLOnVj8gDmUWVjmIoT/VG9jp7SfNo6sODlp9SpYc0LLbV2BYoR+diZH/IV2UflIN8yku6Jv6w5BLoND2P7nP6zJVZ1Q6SgbzM3CNcAUxcFBtjTCfwONQNN9wwdYu6MWZ0mLggCi9XTx9x4h03q1evDo9UtH0EZ64xcQEQHhvLve7BmGHDe8JefPHF4sEHHyxDjDHGGDOqzNg72owxxhgzffAeH75y+bd/+7dlyD7+7b/9t+F9JIO+j242wT8LtG3dujXox4tsZjqJbfC+++6bsa+oGmOMMaY3vNBmjOkMLgZ4KTBs2rQpHBtjRgNeoPzee+8VF198ceifLB6xcacMH7444YQT+n7h72yElyD/1V/9VfgyKy/Wv+mmm8ozxgwf7jLF/uiTxxxzTFjo7eJl+8YYY4wZPn501BjTGVwUxCxfvjx8ft4YMxpwV9s//uM/hq9iwsKFC8MXyfiCo+/W2h90xQLkkiVLiv/+3/+7FznMtPLnP/85fE11586d4ct7M/11YGOMMca0xwttxhhjjDHGGGOMMcZ0gB8dNcYYY4wxxhhjjDGmA7zQZowxxhhjjDHGGGNMB3ihzRhjjDHGGGOMMcaYDvBCmzHGGGOMMcYYY4wxHeCFNmOMMcYYY4wxxhhjBqYo/j+hu8kqbZbmuQAAAABJRU5ErkJggg==\" style=\"width: 970px; height: 374.879px;\" width=\"970\" height=\"374.879\"\u003e\u003cbr\u003e\u003c/div\u003e\n \u003c/div\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eMain findings\u003c/h2\u003e \u003cp\u003e In this study, we retrospectively evaluated guideline implementation in routine palliative care by investigating how the level of pain, dyspnea, constipation, and depression changed from the start of specialist palliative care to 1\u0026ndash;4 weeks later and whether the change in each of the four symptoms was associated with the timing of guideline implementation and receiving treatment according to clinical guidelines.\u003c/p\u003e \u003cp\u003e We found that the levels of pain, dyspnea, constipation, and depression decreased significantly among the advanced cancer patients in specialist palliative care who qualified for the guidelines. The timing of guideline implementation and receiving treatment according to guidelines was associated with improvement of only one of the four symptoms, i.e., dyspnea, where a significantly larger improvement in dyspnea was observed after services started the implementation of the dyspnea guideline. To our surprise, dyspnea decreased more among those patients who did not receive treatment according to the corresponding guideline than among those who did.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eComparison with previous literature\u003c/h2\u003e \u003cp\u003eThe overall improvement in pain, dyspnea, constipation and depression observed during our project is line with a previous longitudinal study reporting that after 6 weeks of implementing the American Society of Clinical Oncology palliative care clinical guidelines in two palliative care clinics, 31 advanced cancer patients significantly improved pain, fatigue and anxiety measured by the Edmonton Symptom Assessment System (ESAS).\u003csup\u003e17\u003c/sup\u003e Similarly, a randomized controlled trial found that lung cancer patients assigned to the early palliative care (n\u0026thinsp;=\u0026thinsp;60), i.e., where physicians and nurses had to implement and follow ambulatory clinical guidelines for symptom control during 12 weeks, had better quality of life and reduced depression than patients assigned to the standard care group (n\u0026thinsp;=\u0026thinsp;40).\u003csup\u003e18\u003c/sup\u003e\u003c/p\u003e \u003cp\u003e In the current study, the improvement observed in the levels of pain, constipation and depression during the project were not significantly associated with the timing of guideline implementation or receiving treatment according to guidelines. This is similar to what was reported in a randomized controlled trial, where no difference was seen after 1\u0026ndash;4 weeks between 329 advanced cancer patients who received interventions recommended in the pain guidelines for moderate to severe pain and 359 patients who received usual care.\u003csup\u003e20\u003c/sup\u003e In our study, this may have happened because patients were treated equally well for pain and other symptoms regardless of whether physicians reported that they had followed the relevant guidelines for treating each symptom. Also, the clinical guidelines were known at the time and may not have revealed any new practices, so well-trained palliative care physicians' knowledge and ability to help patients would be the same before and after their implementation.\u003c/p\u003e \u003cp\u003e The small (4.9 on a 0-100 scale) but significant improvement observed for dyspnea scores after the services started the implementation of the dyspnea guideline and among those patients who did not receive treatment according to the dyspnea guideline may be random findings, which may be related to several pragmatic reasons, for example, whether physicians had sufficient time and motivation to complete the paper survey informing whether they followed or not a relevant guideline for each patient. However, the improvement related to implementation of guidelines may also reveal that a true improvement in care took place. As we reported in our previous study,\u003csup\u003e35\u003c/sup\u003e qualitative data to understand the barriers (or facilitators) that clinicians may have had implementing the four guidelines and to what extent they viewed treatment according to the guidelines as different from their usual practice was not collected during the project.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eStrengths and limitations\u003c/h2\u003e \u003cp\u003eOne of the strengths of this study is that it included a large sample of 3,879 cancer patients admitted to all specialist palliative care services in Denmark, who completed symptom assessments over time. Although we found significant improvement in the four symptoms during the project, there were some limitations that should be acknowledged. Our study did not use randomised allocation to a defined control group (receiving usual treatment) and an intervention group (receiving interventions clearly different treatment), as previous control trials did.\u003csup\u003e18\u0026ndash;20\u003c/sup\u003e Instead we evaluated the impact of implementation based on the temporal pattern (before/after). Whether patients \u0026lsquo;received\u0026rsquo; or \u0026lsquo;did not receive\u0026rsquo; treatment according to guideline was based on registrations from physicians on each patient and this registration may to some extent be subjective, and physicians may in some cases have forgotten to register when treatment was provided according to guidelines. It should also be noted that this project only included patients reporting high levels of pain, dyspnea, constipation or depression (i.e., scores 3\u0026ndash;4 in the EORTC QLQ-C15-PAL) at admittance to palliative care, allowing more room for improvement, since the literature has shown that patients with high initial scores tend to show greatest improvement over time.\u003csup\u003e37, 38\u003c/sup\u003e This is important to be aware of when interpreting the magnitude of change in scores over time for each symptom. However, this concerns all patients in the study and secured that the guidelines were studied in a relevant patient population.\u003c/p\u003e \u003cp\u003e Future studies investigating the effect of implementing clinical guidelines for the treatment of symptoms in patients in palliative care should ideally identify patients who do or do not receive treatment according to the guidelines via random allocation to intervention group versus control group and with more detailed registration of the impact on guidelines on the specific treatments and care delivered. Additionally, implementation strategies, such as team meetings, staff training and educational programs, should be maintained throughout the implementation period to ensure that clinicians improve their adherence to clinical guidelines.\u003csup\u003e39\u003c/sup\u003e\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusions","content":"\u003cp\u003eIn this project, patients with advanced cancer reported improved pain, dyspnea, constipation and depression. However, this symptom improvement was not associated with the implementation of the four guidelines in routine palliative care, maybe except for a small improvement in dyspnea.\u003c/p\u003e \u003cp\u003e We cannot conclude that the implementation of the guidelines did not have a positive effect on patients\u0026rsquo; symptoms, since the lack of impact found in this study may be attributed to a modest impact on clinical practice or the observational project design.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003e\u003cstrong\u003eDMCG-PAL:\u003c/strong\u003e Danish Multidisciplinary Cancer Group for Palliative Care\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEORTC QLQ-C15-PAL:\u003c/strong\u003e European Organisation for Research and Treatment of Cancer Quality of Life Questionnire-Core-15-Palliative Care\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFig:\u003c/strong\u003e Figure\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eICD-10:\u003c/strong\u003e International Statistical Classification of Diseases and Related Health Problems 10th Revision\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eQLQ-C30:\u003c/strong\u003e EORTC Core Quality of Life Questionnaire\u0026nbsp;\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e:\u0026nbsp;This register-based national study did not require Ethics Committee approval according to Danish law. The study was conducted following the approval from the Danish Data Protection Agency (j.nr.: 2012-58-0004/local j.nr. VD-2019-73).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e:\u0026nbsp;Not applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e:\u0026nbsp;The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u003c/strong\u003e The authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e This study was funded by the\u0026nbsp;Danish Cancer society (grant number R261-A15091).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eLRC and MG: Conceptualization and investigation; MBH and LRC: Methodology and formal analysis; LRC: Writing the first draft; MA, MAP, HL and MG: Writing - review and editing. All authors read and approved the final manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eField MJ and Lohr KN. Guidelines for clinical practice: from development to use. In: Committee on Clinical Practice Guidelines. Institute of Medicine, (ed.). Washington DC: National Academies Press, 1992, p. 440.\u003c/li\u003e\n\u003cli\u003ePanteli D, Legido-Quigley H and Reichebner C. Clinical Practice Guidelines as a quality strategy. In: Busse R, Klazinga N, Panteli D, et al., (eds.). \u003cem\u003eImproving healthcare quality in Europe: Characteristics, effectiveness and implementation of different strategies [Internet]\u003c/em\u003e. Copenhagen (Denmark): European Observatory on Health Systems and Policies and OECD, 2019.\u003c/li\u003e\n\u003cli\u003eVan Beek K, Siouta N, Preston N, et al. To what degree is palliative care integrated in guidelines and pathways for adult cancer patients in Europe: a systematic literature review. \u003cem\u003eBMC Palliat Care\u003c/em\u003e 2016; 15: 26. DOI: 10.1186/s12904-016-0100-0.\u003c/li\u003e\n\u003cli\u003eCaraceni A, Hanks G, Kaasa S, et al. Use of opioid analgesics in the treatment of cancer pain: evidence-based recommendations from the EAPC. \u003cem\u003eLancet Oncol\u003c/em\u003e 2012; 13: e58-e68. DOI: 10.1016/S1470-2045(12)70040-2.\u003c/li\u003e\n\u003cli\u003eCherny N. ESMO Clinical Practice Guidelines for the management of refractory symptoms at the end of life and the use of palliative sedation. \u003cem\u003eAnn Oncol\u003c/em\u003e 2014; 25: iii143-iii152. DOI: 10.1093/annonc/mdu238.\u003c/li\u003e\n\u003cli\u003eOsman H, Shrestha S, Temin S, et al. Palliative care in the global setting: ASCO resource-stratified practice guideline. \u003cem\u003eJ Glob Oncol\u003c/em\u003e 2018: 1\u0026ndash;24. DOI: 10.1200/jgo.18.00026.\u003c/li\u003e\n\u003cli\u003eCrawford G, Dzierżanowski T, Hauser K, et al. Care of the adult cancer patient at the end of life: ESMO Clinical Practice Guidelines☆. \u003cem\u003eESMO open\u003c/em\u003e 2021; 6. DOI: 10.1016/j.esmoop.2021.100225.\u003c/li\u003e\n\u003cli\u003eGerman Society for Palliative Medicine. Extended S3 Guideline Palliative Care for Patients with an Incurable Cancer [Erweiterte S3-Leitlinie Palliativmedizin f\u0026uuml;r Patienten mit einer nicht heilbaren Krebserkrankung]. The AWMF (Working Group of Scientific Medical Societies) 2021, p. 1-216.\u003c/li\u003e\n\u003cli\u003eGreater Manchester Medicine Management Group (GMMMG). Palliative care: Pain and symptom control guidelines for adults. 2019, p. 1-128.\u003c/li\u003e\n\u003cli\u003eThe Irish Health Service Executive. Management of constipation in adult patients receiving palliative care. National clinical guideline No. 10. 2015, p. 1-94.\u003c/li\u003e\n\u003cli\u003eRegional Cancer Center Stockholm Gotland. National Clinical Practice Guidelines for Palliative care 2012\u0026ndash;2014 [Nationellt V\u0026aring;rdprogram f\u0026ouml;r Palliativ V\u0026aring;rd 2012-2014]. Regional Cancer Center in Cooperation, Sweden, 2012, p. 60-110.\u003c/li\u003e\n\u003cli\u003eThe National Health Service NHS Scotland. Caring for people in the last days and hours of life - Guidance. 2014, p. 1-15.\u003c/li\u003e\n\u003cli\u003eGoverment of Western Australia and Palliative Care Network. Evidence based clinical guidelines for adults in the terminal phase. Second ed. 2010, p. 1-47.\u003c/li\u003e\n\u003cli\u003ePrior M, Guerin M and Grimmer-Somers K. The effectiveness of clinical guideline implementation strategies \u0026ndash; a synthesis of systematic review findings. \u003cem\u003eJ Eval Clin Pract\u003c/em\u003e 2008; 14: 888-897. DOI: 10.1111/j.1365-2753.2008.01014.x.\u003c/li\u003e\n\u003cli\u003eFerrell BR, Twaddle ML, Melnick A, et al. National consensus project clinical practice guidelines for quality palliative care guidelines. \u003cem\u003eJ Palliat Med\u003c/em\u003e 2018; 21: 1684-1689. DOI: 10.1089/jpm.2018.0431.\u003c/li\u003e\n\u003cli\u003eLau BD, Aslakson RA, Wilson RF, et al. Methods for improving the quality of palliative care delivery: a systematic review. \u003cem\u003eAm J Hosp Palliat Care\u003c/em\u003e 2014; 31: 202-210. 20130326. DOI: 10.1177/1049909113482039.\u003c/li\u003e\n\u003cli\u003eKoesel N, Tocchi C, Burke L, et al. Symptom distress: Implementation of Palliative Care Guidelines to Improve Pain, Fatigue, and Anxiety in Patients With Advanced Cancer. \u003cem\u003eClin J Oncol Nurs\u003c/em\u003e 2019; 23: 149-155. DOI: 10.1188/19.CJON.149-155.\u003c/li\u003e\n\u003cli\u003eTemel JS, Greer JA, Muzikansky A, et al. Early palliative care for patients with metastatic non-small-cell lung cancer. \u003cem\u003eN Engl J Med\u003c/em\u003e 2010; 363: 733-742. DOI: 10.1056/NEJMoa1000678.\u003c/li\u003e\n\u003cli\u003eBakitas M, Lyons KD, Hegel MT, et al. Effects of a Palliative Care Intervention on Clinical Outcomes in Patients With Advanced Cancer: The Project ENABLE II Randomized Controlled Trial. \u003cem\u003eJAMA\u003c/em\u003e 2009; 302: 741-749. DOI: 10.1001/jama.2009.1198.\u003c/li\u003e\n\u003cli\u003eLovell MR, Phillips JL, Luckett T, et al. Effect of Cancer Pain Guideline Implementation on Pain Outcomes Among Adult Outpatients With Cancer-Related Pain: A Stepped Wedge Cluster Randomized Trial. \u003cem\u003eJAMA Netw Open\u003c/em\u003e 2022; 5: e220060. 20220201. DOI: 10.1001/jamanetworkopen.2022.0060.\u003c/li\u003e\n\u003cli\u003eDanish Regions. Learning and quality teams-LKT in specialized palliative care: project description [L\u0026aelig;rings og kvalitetsteam p\u0026aring; det specialiserede palliative omr\u0026aring;de: projekt beskrivelse]. 2016, p. 1-27.\u003c/li\u003e\n\u003cli\u003eGroenvold M, Petersen MA, Aaronson NK, et al. The development of the EORTC QLQ-C15-PAL: a shortened questionnaire for cancer patients in palliative care. \u003cem\u003eEur J Cancer\u003c/em\u003e 2006; 42: 55-64. DOI: 10.1093/jnci/85.5.36510.1016/j.ejca.2005.06.022.\u003c/li\u003e\n\u003cli\u003eProctor E, Silmere H, Raghavan R, et al. Outcomes for implementation research: conceptual distinctions, measurement challenges, and research agenda. \u003cem\u003eAdm Policy Ment Health\u003c/em\u003e 2011; 38: 65-76. DOI: 10.1007/s10488-010-0319-7.\u003c/li\u003e\n\u003cli\u003eHansen MB, Adsersen M and Groenvold M. Report from the Danish Palliative Database 2021 [\u0026Aring;rsrapport for Dansk Palliativ Database 2021]. 2022, p. 1-103.\u003c/li\u003e\n\u003cli\u003eGroenvold M, Adsersen M and Hansen MB. Danish palliative care database. \u003cem\u003eClin Epidemiol\u003c/em\u003e 2016; 8: 637-643. DOI: 10.2147/clep.s99468.\u003c/li\u003e\n\u003cli\u003eDanish Health Authority. Recommendations for Palliative Care [Anbefalinger For Den Palliativ Indsats] 2017, p. 1-54.\u003c/li\u003e\n\u003cli\u003eHansen MB, Adsersen M and Groenvold M. Report from the Danish Palliative Database 2019 [\u0026Aring;rsrapport for Dansk Palliativ Database 2019]. 2020, p. 1-71.\u003c/li\u003e\n\u003cli\u003eDanish Health Authority. Danish Regions: The national quality program [Danske Regioner: Det nationale kvalitetsprogram], https://www.regioner.dk/sundhed/kvalitet-og-styring/det-nationale-kvalitetsprogram (2016, accessed 15 Jan 2023).\u003c/li\u003e\n\u003cli\u003eDanish Multidisciplinary Cancer Group for Palliative Care (DMCG-PAL). Approved clinical guidelines [Godkendte retningslinjer], http://www.dmcgpal.dk/661/godkendteretningslinjer (2013, accessed 12 May 2023).\u003c/li\u003e\n\u003cli\u003eDanish Multidisciplinary Cancer Group for Palliative Care (DMCG-PAL). Clinical guideline for pain treatment with strong opioids [Klinisk retningslinje for smertebehandling med st\u0026aelig;rke opioider], http://www.dmcgpal.dk/files/opioider_221020.pdf (2015, accessed 30 July 2023).\u003c/li\u003e\n\u003cli\u003eDanish Multidisciplinary Cancer Group for Palliative Care (DMCG-PAL). Pharmacological interventions to relieve refractory dyspnea in adult cancer patients in terminal palliative phase [Farmakologiske interventioner til lindring af refrakt\u0026aelig;r dyspn\u0026oslash; hos voksne kr\u0026aelig;ftpatienter i sen eller terminal palliativ fase], http://www.dmcgpal.dk/files/kliniske-retningslinjer/dyspnoe/farma_dyspn__til_publikation-1.pdf (2019, accessed 18 July 2023).\u003c/li\u003e\n\u003cli\u003eDanish Multidisciplinary Cancer Group for Palliative Care (DMCG-PAL). Clinical guideline for the pharmacological treatment of constipation [Klinisk retningslinje om farmakologisk behandling af obstipation] http://www.dmcgpal.dk/files/obstipation_farma_221020.pdf (2017, accessed 20 July 2023).\u003c/li\u003e\n\u003cli\u003eDanish Multidisciplinary Cancer Group for Palliative Care (DMCG-PAL). Clinical guideline for the treatment of clinical depression in cancer patients \u0026ge;18 years [Klinisk retningslinje for behandling af klinisk depression hos kr\u0026aelig;ftpatienter \u0026ge;18 \u0026aring;r], http://www.dmcgpal.dk/files/depression_voksne_221020.pdf (2017, accessed 21 July 2023).\u003c/li\u003e\n\u003cli\u003eDanish Multidisciplinary Cancer Group for Palliative Care (DMCG-PAL). Clinical guideline for interventions that support adult relatives of cancer patients in palliative care [Klinisk retningslinje om interventioner, der st\u0026oslash;tter voksne p\u0026aring;r\u0026oslash;rende til kr\u0026aelig;ftpatienter i palliativt forl\u0026oslash;b], http://www.dmcgpal.dk/files/kliniske-retningslinjer/paaroeende/dmcgpal_voksne-parorende_adm_godk_260819.pdf (2013, accessed 31 July 2023).\u003c/li\u003e\n\u003cli\u003eRojas-Concha L, Hansen MB, Adsersen M, et al. Implementation of clinical guidelines in specialized palliative care\u0026mdash;results from a national improvement project: A national register-based study. \u003cem\u003ePalliat Med\u003c/em\u003e 2023; 37: 749-759. DOI: 10.1177/02692163231155977.\u003c/li\u003e\n\u003cli\u003eGroenvold M and Petersen MA. Addendum to the EORTC QLQ-C30 scoring manual: scoring of the EORTC QLQ-C15-PAL. \u003cem\u003eEORTC Quality of Life Group, Brussels\u003c/em\u003e 2006: 1-10.\u003c/li\u003e\n\u003cli\u003eRasmussen CL, Johnsen AT, Petersen MA, et al. Change in health-related quality of life over 1 month in cancer patients with high initial levels of symptoms and problems. \u003cem\u003eQual Life Res\u003c/em\u003e 2016; 25: 2669\u0026ndash;2674. DOI: 10.1007/s11136-016-1287-5.\u003c/li\u003e\n\u003cli\u003eModonesi C, Scarpi E, Maltoni M, et al. Impact of Palliative Care Unit Admission on Symptom Control Evaluated by the Edmonton Symptom Assessment System. \u003cem\u003eJ Pain Symptom Manage\u003c/em\u003e 2005; 30: 367-373. DOI: 10.1016/j.jpainsymman.2005.04.007.\u003c/li\u003e\n\u003cli\u003eButow P, Faris MM, Shaw J, et al. Effect of core versus enhanced implementation strategies on adherence to a clinical pathway for managing anxiety and depression in cancer patients in routine care: a cluster randomised controlled trial. \u003cem\u003eImplement Sci\u003c/em\u003e 2023; 18: 18. DOI: 10.1186/s13012-023-01269-0.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-palliative-care","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pcar","sideBox":"Learn more about [BMC Palliative Care](http://bmcpalliatcare.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pcar/default.aspx","title":"BMC Palliative Care","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Implementation, Clinical Guidelines, Palliative Care, Pain, Dyspnea, Constipation, Depression, Quality of Life","lastPublishedDoi":"10.21203/rs.3.rs-4595052/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4595052/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e There is limited evidence on whether the implementation of clinical guidelines has a positive effect on the symptomatology of cancer patients in palliative care. A large national project conducted 2017-2019 aimed to improve the quality of life of cancer patients by implementing clinical guidelines for severe pain, dyspnea, constipation and depression in Danish specialist palliative care. We investigated how pain, dyspnea, constipation and depression changed from the start of palliative care to 1-4 weeks later and whether changes were associated with timing of guideline implementation and with receipt of treatment according to guidelines.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eA prospective, national quality improvement study.\u003cstrong\u003e \u003c/strong\u003eData for the project was obtained from the Danish Palliative Care Database. We included adult patients with advanced cancer who answered the European Organisation for Research and Treatment of Cancer Quality of Life Questionnire-Core-15-Palliative Care (EORTC QLQ-C15-PAL) questionnaire at the start of specialist palliative care and 1-4 weeks later. Multiple linear regression evaluated associations between changes in symptom severity and timing of guideline implementation and receiving treatment according to guidelines.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eOf 4,640 patients completing both EORTC QLQ-C15-PAL questionnaires, 3,879 (84%) qualified for one or more treatment guidelines. Pain, dyspnea, constipation and depression improved significantly. Timing of guideline implementation and receiving treatment according to guidelines were not associated with improvement, except for dyspnea, where small associations were observed.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e Patients reported improved pain, dyspnea, constipation and depression, but this improvement was not consistently associated with the implementation of the four guidelines in palliative care. The lack of impact may be attributed to a modest impact on clinical practice or the observational project design.\u003c/p\u003e","manuscriptTitle":"Effect of implementing clinical guidelines for treatment of symptoms in advanced cancer patients in specialist palliative care: A nationwide register-based study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-07-16 15:48:23","doi":"10.21203/rs.3.rs-4595052/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-04-08T14:04:04+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-09-06T09:42:21+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-09-03T17:25:54+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-08-30T13:43:04+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"274368908774792711900414275930305660965","date":"2024-08-27T20:24:51+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"233875090030179301851813610047268736196","date":"2024-08-25T15:32:03+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"33889048063344261594861581729548916902","date":"2024-08-14T14:21:38+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-08-08T17:11:22+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2024-06-18T11:12:27+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-06-18T07:30:39+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-06-18T07:30:16+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Palliative Care","date":"2024-06-17T15:18:36+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-palliative-care","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pcar","sideBox":"Learn more about [BMC Palliative Care](http://bmcpalliatcare.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pcar/default.aspx","title":"BMC Palliative Care","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"40a688b3-062f-445a-8603-f8470713c3ac","owner":[],"postedDate":"July 16th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-12-15T16:09:00+00:00","versionOfRecord":{"articleIdentity":"rs-4595052","link":"https://doi.org/10.1186/s12904-025-01969-y","journal":{"identity":"bmc-palliative-care","isVorOnly":false,"title":"BMC Palliative Care"},"publishedOn":"2025-12-10 15:59:09","publishedOnDateReadable":"December 10th, 2025"},"versionCreatedAt":"2024-07-16 15:48:23","video":"","vorDoi":"10.1186/s12904-025-01969-y","vorDoiUrl":"https://doi.org/10.1186/s12904-025-01969-y","workflowStages":[]},"version":"v1","identity":"rs-4595052","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4595052","identity":"rs-4595052","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}